World Diabetes Congress

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

[email protected]

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

[email protected]

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

[email protected]

VANCOUVER – Breastfeeding was associated with a reduced risk of type 2 diabetes in an analysis of 250,392 children born to 180,107 women in the Canadian province of Manitoba.

Data were culled from hospital records, which captured the initiation of breastfeeding in the hospital, but not the subsequent duration. First-nation women have higher rates of diabetes than do others in Manitoba, so the investigators assessed the benefits of their breastfeeding separately. Initiating breastfeeding in the hospital was associated with a 23% reduced risk of diabetes among non–first nation mothers (HR 0.768, 95% CI: 0.719-0.820, P less than .0001) and a 14% reduced risk of diabetes among first nation mothers (HR 0.859, 95% CI 0.799-0.9230, P less than .0001), investigators at the University of Manitoba in Winnipeg reported at the World Diabetes Congress.

Initiating breastfeeding in the hospital also protected children against type 2 diabetes during up to 24 years of follow-up (HR 0.821, CI 0.686-0.983, P = .0317). Just a small percentage of children – 0.2% among the breastfed, and 0.4% among those not breastfed – developed type 2 diabetes during follow-up.

After the researchers controlled for a range of potential confounders, the findings were independent of gestational diabetes, gestational hypertension, family income, and location of residence, age of mother at birth, parity, and birth weight of offspring.

“We believe this is the first study to provide evidence that breastfeeding initiation has a significant impact on diabetes in both mothers and children. We recommend enhanced education on breastfeeding initiation and duration,” said Dr. Gary Shen, professor of endocrinology and metabolism at the university.

The women were in their mid-20s, on average. About 56% of first-nation and 83% of non–first-nation women started breast feeding in the hospital. Gestational diabetes, children born small for gestational age, low income, and rural living were more common among women who did not breastfeed.

The prevalence of diabetes and obesity is up to three times higher in first nation people than in the general population of Manitoba, according to Dr. Shen.

He and his colleagues have launched an education website for moms-to-be called “Moms in Motion.” They had no conflicts of interest to disclose.

[email protected]

VANCOUVER – Breastfeeding was associated with a reduced risk of type 2 diabetes in an analysis of 250,392 children born to 180,107 women in the Canadian province of Manitoba.

Data were culled from hospital records, which captured the initiation of breastfeeding in the hospital, but not the subsequent duration. First-nation women have higher rates of diabetes than do others in Manitoba, so the investigators assessed the benefits of their breastfeeding separately. Initiating breastfeeding in the hospital was associated with a 23% reduced risk of diabetes among non–first nation mothers (HR 0.768, 95% CI: 0.719-0.820, P less than .0001) and a 14% reduced risk of diabetes among first nation mothers (HR 0.859, 95% CI 0.799-0.9230, P less than .0001), investigators at the University of Manitoba in Winnipeg reported at the World Diabetes Congress.

Initiating breastfeeding in the hospital also protected children against type 2 diabetes during up to 24 years of follow-up (HR 0.821, CI 0.686-0.983, P = .0317). Just a small percentage of children – 0.2% among the breastfed, and 0.4% among those not breastfed – developed type 2 diabetes during follow-up.

After the researchers controlled for a range of potential confounders, the findings were independent of gestational diabetes, gestational hypertension, family income, and location of residence, age of mother at birth, parity, and birth weight of offspring.

“We believe this is the first study to provide evidence that breastfeeding initiation has a significant impact on diabetes in both mothers and children. We recommend enhanced education on breastfeeding initiation and duration,” said Dr. Gary Shen, professor of endocrinology and metabolism at the university.

The women were in their mid-20s, on average. About 56% of first-nation and 83% of non–first-nation women started breast feeding in the hospital. Gestational diabetes, children born small for gestational age, low income, and rural living were more common among women who did not breastfeed.

The prevalence of diabetes and obesity is up to three times higher in first nation people than in the general population of Manitoba, according to Dr. Shen.

He and his colleagues have launched an education website for moms-to-be called “Moms in Motion.” They had no conflicts of interest to disclose.

[email protected]

VANCOUVER – Breastfeeding was associated with a reduced risk of type 2 diabetes in an analysis of 250,392 children born to 180,107 women in the Canadian province of Manitoba.

Data were culled from hospital records, which captured the initiation of breastfeeding in the hospital, but not the subsequent duration. First-nation women have higher rates of diabetes than do others in Manitoba, so the investigators assessed the benefits of their breastfeeding separately. Initiating breastfeeding in the hospital was associated with a 23% reduced risk of diabetes among non–first nation mothers (HR 0.768, 95% CI: 0.719-0.820, P less than .0001) and a 14% reduced risk of diabetes among first nation mothers (HR 0.859, 95% CI 0.799-0.9230, P less than .0001), investigators at the University of Manitoba in Winnipeg reported at the World Diabetes Congress.

Initiating breastfeeding in the hospital also protected children against type 2 diabetes during up to 24 years of follow-up (HR 0.821, CI 0.686-0.983, P = .0317). Just a small percentage of children – 0.2% among the breastfed, and 0.4% among those not breastfed – developed type 2 diabetes during follow-up.

After the researchers controlled for a range of potential confounders, the findings were independent of gestational diabetes, gestational hypertension, family income, and location of residence, age of mother at birth, parity, and birth weight of offspring.

“We believe this is the first study to provide evidence that breastfeeding initiation has a significant impact on diabetes in both mothers and children. We recommend enhanced education on breastfeeding initiation and duration,” said Dr. Gary Shen, professor of endocrinology and metabolism at the university.

The women were in their mid-20s, on average. About 56% of first-nation and 83% of non–first-nation women started breast feeding in the hospital. Gestational diabetes, children born small for gestational age, low income, and rural living were more common among women who did not breastfeed.

The prevalence of diabetes and obesity is up to three times higher in first nation people than in the general population of Manitoba, according to Dr. Shen.

He and his colleagues have launched an education website for moms-to-be called “Moms in Motion.” They had no conflicts of interest to disclose.

[email protected]

VANCOUVER – A new stem cell transplant approach addressed both underlying autoimmunity and pancreatic beta-cell repair and regeneration in a pilot study of patients with established type 1 diabetes mellitus.

In an open-label, randomized, controlled trial of 42 patients, cotransplantation of umbilical cord mesenchymal stromal cells and autologous bone marrow mononuclear cells, without any immunotherapy, was tested against usual care.

Susan London/Frontline Medical News

At 1 year, the area under the curve for C-peptide during an oral glucose tolerance test had more than doubled among the transplant recipients, whereas it had fallen among those managed with usual care, presenting author Xiumin Xu reported at the World Diabetes Congress. The transplant group also saw greater improvements in other metabolic measures, in immune indicators, and in scores for mental well-being and quality of life.

Overall, the transplant procedure was safe and well tolerated, she reported. Severe hypoglycemic events were less common in the transplant group. One patient had transient abdominal pain during the procedure, and another had bleeding at the site where the infusion catheter was placed.

“Although the absolute change in C-peptide is marginal, it is relatively significant in view of the long disease duration,” commented Ms. Xu, a researcher with the Diabetes Research Institute, Cell Transplant Center, University of Miami; The Cure Alliance, Miami; and the Diabetes Research Institute Federation in Hollywood, Fla.

The trial was unusual in enrolling patients with established diabetes, Ms. Xu pointed out. Most type 1 diabetes studies have enrolled patients with recent disease onset, but increasing evidence suggests some preservation of beta-cell mass and C-peptide production in those with established disease.

The researchers tapped mesenchymal cells for transplant because of their known ability to modulate immune response and tissue repair through paracrine mechanisms. In a preclinical model of diabetes, combining these cells with bone marrow cells synergistically improved glycemia and insulin levels (Stem Cells. 2008;26:244-53).

The trial, conducted in China, enrolled patients 18-40 years old who had type 1 diabetes for at least 2 years and were otherwise generally healthy. They were required to have a hemoglobin A_1c level of 7.5%-10.5%, a fasting serum C-peptide level of less than 0.1 pmol/mL, and a daily insulin requirement of less than 100 IU.

The transplant group underwent sequential infusion of autologous bone marrow cells and umbilical cord mesenchymal stromal cells over 30 minutes through supraselective pancreatic artery cannulation. The control group continued to receive usual clinical care.

Trial results, reported at the congress and recently published (Diabetes Care January 2016. 39[1]:149-157), showed that transplant recipients, compared with their usual care counterparts, had improvements in the area under the curve for C-peptide (+105.7% vs. –7.7%, P = .013), the trial’s primary endpoint.

They also had improvements in the area under the curve for insulin (+49.3% vs. –5.7%, P = .027), hemoglobin A_1c (–12.6% vs. +1.2%, P less than .01), fasting blood glucose (–24.4% vs. –4.3%, P less than .05), and daily insulin requirements (–29.2% vs. 0%, P less than .01).

“Although metabolic control improved in patients receiving stem cell transplant, insulin independence was not achieved,” noted Ms. Xu, who disclosed that she had no relevant conflicts of interest.

The transplant group also had more favorable changes in markers of immune function, such as an increase in interleukin-10 levels and a decrease in serum interferon-gamma levels.

Additionally, they had significant improvements in scores for anxiety, depression, and quality of life relative to their usual care peers.

[email protected]

VANCOUVER – A new stem cell transplant approach addressed both underlying autoimmunity and pancreatic beta-cell repair and regeneration in a pilot study of patients with established type 1 diabetes mellitus.

In an open-label, randomized, controlled trial of 42 patients, cotransplantation of umbilical cord mesenchymal stromal cells and autologous bone marrow mononuclear cells, without any immunotherapy, was tested against usual care.

Susan London/Frontline Medical News

At 1 year, the area under the curve for C-peptide during an oral glucose tolerance test had more than doubled among the transplant recipients, whereas it had fallen among those managed with usual care, presenting author Xiumin Xu reported at the World Diabetes Congress. The transplant group also saw greater improvements in other metabolic measures, in immune indicators, and in scores for mental well-being and quality of life.

Overall, the transplant procedure was safe and well tolerated, she reported. Severe hypoglycemic events were less common in the transplant group. One patient had transient abdominal pain during the procedure, and another had bleeding at the site where the infusion catheter was placed.

“Although the absolute change in C-peptide is marginal, it is relatively significant in view of the long disease duration,” commented Ms. Xu, a researcher with the Diabetes Research Institute, Cell Transplant Center, University of Miami; The Cure Alliance, Miami; and the Diabetes Research Institute Federation in Hollywood, Fla.

The trial was unusual in enrolling patients with established diabetes, Ms. Xu pointed out. Most type 1 diabetes studies have enrolled patients with recent disease onset, but increasing evidence suggests some preservation of beta-cell mass and C-peptide production in those with established disease.

The researchers tapped mesenchymal cells for transplant because of their known ability to modulate immune response and tissue repair through paracrine mechanisms. In a preclinical model of diabetes, combining these cells with bone marrow cells synergistically improved glycemia and insulin levels (Stem Cells. 2008;26:244-53).

The trial, conducted in China, enrolled patients 18-40 years old who had type 1 diabetes for at least 2 years and were otherwise generally healthy. They were required to have a hemoglobin A_1c level of 7.5%-10.5%, a fasting serum C-peptide level of less than 0.1 pmol/mL, and a daily insulin requirement of less than 100 IU.

The transplant group underwent sequential infusion of autologous bone marrow cells and umbilical cord mesenchymal stromal cells over 30 minutes through supraselective pancreatic artery cannulation. The control group continued to receive usual clinical care.

Trial results, reported at the congress and recently published (Diabetes Care January 2016. 39[1]:149-157), showed that transplant recipients, compared with their usual care counterparts, had improvements in the area under the curve for C-peptide (+105.7% vs. –7.7%, P = .013), the trial’s primary endpoint.

They also had improvements in the area under the curve for insulin (+49.3% vs. –5.7%, P = .027), hemoglobin A_1c (–12.6% vs. +1.2%, P less than .01), fasting blood glucose (–24.4% vs. –4.3%, P less than .05), and daily insulin requirements (–29.2% vs. 0%, P less than .01).

“Although metabolic control improved in patients receiving stem cell transplant, insulin independence was not achieved,” noted Ms. Xu, who disclosed that she had no relevant conflicts of interest.

The transplant group also had more favorable changes in markers of immune function, such as an increase in interleukin-10 levels and a decrease in serum interferon-gamma levels.

Additionally, they had significant improvements in scores for anxiety, depression, and quality of life relative to their usual care peers.

[email protected]

VANCOUVER – A new stem cell transplant approach addressed both underlying autoimmunity and pancreatic beta-cell repair and regeneration in a pilot study of patients with established type 1 diabetes mellitus.

In an open-label, randomized, controlled trial of 42 patients, cotransplantation of umbilical cord mesenchymal stromal cells and autologous bone marrow mononuclear cells, without any immunotherapy, was tested against usual care.

Susan London/Frontline Medical News

At 1 year, the area under the curve for C-peptide during an oral glucose tolerance test had more than doubled among the transplant recipients, whereas it had fallen among those managed with usual care, presenting author Xiumin Xu reported at the World Diabetes Congress. The transplant group also saw greater improvements in other metabolic measures, in immune indicators, and in scores for mental well-being and quality of life.

Overall, the transplant procedure was safe and well tolerated, she reported. Severe hypoglycemic events were less common in the transplant group. One patient had transient abdominal pain during the procedure, and another had bleeding at the site where the infusion catheter was placed.

“Although the absolute change in C-peptide is marginal, it is relatively significant in view of the long disease duration,” commented Ms. Xu, a researcher with the Diabetes Research Institute, Cell Transplant Center, University of Miami; The Cure Alliance, Miami; and the Diabetes Research Institute Federation in Hollywood, Fla.

The trial was unusual in enrolling patients with established diabetes, Ms. Xu pointed out. Most type 1 diabetes studies have enrolled patients with recent disease onset, but increasing evidence suggests some preservation of beta-cell mass and C-peptide production in those with established disease.

The researchers tapped mesenchymal cells for transplant because of their known ability to modulate immune response and tissue repair through paracrine mechanisms. In a preclinical model of diabetes, combining these cells with bone marrow cells synergistically improved glycemia and insulin levels (Stem Cells. 2008;26:244-53).

The trial, conducted in China, enrolled patients 18-40 years old who had type 1 diabetes for at least 2 years and were otherwise generally healthy. They were required to have a hemoglobin A_1c level of 7.5%-10.5%, a fasting serum C-peptide level of less than 0.1 pmol/mL, and a daily insulin requirement of less than 100 IU.

The transplant group underwent sequential infusion of autologous bone marrow cells and umbilical cord mesenchymal stromal cells over 30 minutes through supraselective pancreatic artery cannulation. The control group continued to receive usual clinical care.

Trial results, reported at the congress and recently published (Diabetes Care January 2016. 39[1]:149-157), showed that transplant recipients, compared with their usual care counterparts, had improvements in the area under the curve for C-peptide (+105.7% vs. –7.7%, P = .013), the trial’s primary endpoint.

They also had improvements in the area under the curve for insulin (+49.3% vs. –5.7%, P = .027), hemoglobin A_1c (–12.6% vs. +1.2%, P less than .01), fasting blood glucose (–24.4% vs. –4.3%, P less than .05), and daily insulin requirements (–29.2% vs. 0%, P less than .01).

“Although metabolic control improved in patients receiving stem cell transplant, insulin independence was not achieved,” noted Ms. Xu, who disclosed that she had no relevant conflicts of interest.

The transplant group also had more favorable changes in markers of immune function, such as an increase in interleukin-10 levels and a decrease in serum interferon-gamma levels.

Additionally, they had significant improvements in scores for anxiety, depression, and quality of life relative to their usual care peers.

[email protected]

VANCOUVER – It may be time to reconsider the criteria used to select obese patients with type 2 diabetes mellitus for bariatric surgery, according to data from a pooled cohort study.

Typically, diabetic patients are considered eligible only if they have a body mass index of at least 35 kg/m² and poorly controlled glycemia, according to lead author Dr. Geltrude Mingrone, department of internal medicine, Catholic University, Rome, and department of diabetes and nutritional sciences, King’s College, London.

But in her team’s new analysis of 727 patients, the best predictors of remission after bariatric surgery were a lower fasting glucose level, shorter diabetes duration at baseline, and having a gastric procedure with diversion, she reported at the World Diabetes Congress. And the best baseline predictors of improved glycemic control after bariatric surgery were lower waist circumference, better diabetes control, and lower triglyceride levels.

“We can say that there is a clear advantage of an early operation on diabetes remission that is independent of baseline body mass index. Baseline waist circumference and HOMA-IR [homeostasis model assessment of insulin resistance] are better predictors of glycemic control after bariatric surgery than body mass index,” Dr. Mingrone maintained.

“So I would like to advise the scientific community … to try to define new criteria for the selection of diabetic patients for metabolic surgery. Also, [it is important] because all over the world, the number of bariatric operations is only 250,000, a quarter of a million, while the potential eligible patients are many, many millions,” she concluded.

“I completely concur with Professor Mingrone – we need to come up with criteria for utilizing this procedure,” session comoderator Dr. Robert E. Ratner said in an interview.

“There are so many millions of individuals with diabetes, we cannot be doing surgery on all of them. We need to be selective, and we need to be very specific about why we are doing it and what we are looking for,” elaborated Dr. Rattner, who is a professor of medicine at Georgetown University and senior research scientist at the MedStar Health Research Institute, Washington, as well as chief scientific and medical officer of the American Diabetes Association, Alexandria, Va.

In the new research, the investigators merged databases of the Swedish Obese Subjects (SOS) prospective controlled study (N Engl J Med. 2004;351:2683-93) and two randomized, controlled trials conducted in Australia (JAMA. 2008;299:316-23) and Italy (N Engl J Med. 2012;366:1577-85).

Overall, 415 patients had bariatric surgery (about three-fourths had a gastric-only procedure, while the rest had a gastric procedure plus diversion) and 312 patients had medical management. The mean duration of diabetes at baseline was roughly 3.5 years.

After 2 years the proportion of patients achieving diabetes remission, defined as a fasting plasma glucose of less than 5.6 mmol/L in the absence of any antidiabetes medication, was higher in the surgical group than in the medical group (64% vs. 15%, P less than .001). And within the surgical group, it was higher for those whose operation included a diversion (76% vs. 60%, P = .016).

Among the patients who had surgery, the probability of remission fell with increasing baseline diabetes duration (–0.210), and fasting blood glucose level (–0.145), whereas it rose with increasing body mass index (+0.059). But when the type of surgery was added to the model, body mass index was no longer a significant predictor, and two additional predictors emerged: use of only oral antidiabetic medications versus none (–1.22) and receipt of a procedure with diversion (2.180).

In the subgroup who had a gastric-only procedure, the probability of remission fell with increasing diabetes duration (–0.197), and increasing fasting blood glucose level (–0.186), and it was lower for patients who used only oral antidiabetic medications (–1.364) or insulin with or without oral medications (–1.783). In the subgroup who had a gastric procedure with diversion, the only predictor was diabetes duration (–0.273).

Of note, there was no significant difference in the odds of remission between patients with a body mass index of 35 kg/m² or lower and patients with a body index between 35 and 40 kg/m².

Dr. Mingrone disclosed that she receives lecture fees and travel expenses from Novo Nordisk, and research grants from AstraZeneca, and is a consultant to Fractyl.

VANCOUVER – It may be time to reconsider the criteria used to select obese patients with type 2 diabetes mellitus for bariatric surgery, according to data from a pooled cohort study.

Typically, diabetic patients are considered eligible only if they have a body mass index of at least 35 kg/m² and poorly controlled glycemia, according to lead author Dr. Geltrude Mingrone, department of internal medicine, Catholic University, Rome, and department of diabetes and nutritional sciences, King’s College, London.

But in her team’s new analysis of 727 patients, the best predictors of remission after bariatric surgery were a lower fasting glucose level, shorter diabetes duration at baseline, and having a gastric procedure with diversion, she reported at the World Diabetes Congress. And the best baseline predictors of improved glycemic control after bariatric surgery were lower waist circumference, better diabetes control, and lower triglyceride levels.

“We can say that there is a clear advantage of an early operation on diabetes remission that is independent of baseline body mass index. Baseline waist circumference and HOMA-IR [homeostasis model assessment of insulin resistance] are better predictors of glycemic control after bariatric surgery than body mass index,” Dr. Mingrone maintained.

“So I would like to advise the scientific community … to try to define new criteria for the selection of diabetic patients for metabolic surgery. Also, [it is important] because all over the world, the number of bariatric operations is only 250,000, a quarter of a million, while the potential eligible patients are many, many millions,” she concluded.

“I completely concur with Professor Mingrone – we need to come up with criteria for utilizing this procedure,” session comoderator Dr. Robert E. Ratner said in an interview.

“There are so many millions of individuals with diabetes, we cannot be doing surgery on all of them. We need to be selective, and we need to be very specific about why we are doing it and what we are looking for,” elaborated Dr. Rattner, who is a professor of medicine at Georgetown University and senior research scientist at the MedStar Health Research Institute, Washington, as well as chief scientific and medical officer of the American Diabetes Association, Alexandria, Va.

In the new research, the investigators merged databases of the Swedish Obese Subjects (SOS) prospective controlled study (N Engl J Med. 2004;351:2683-93) and two randomized, controlled trials conducted in Australia (JAMA. 2008;299:316-23) and Italy (N Engl J Med. 2012;366:1577-85).

Overall, 415 patients had bariatric surgery (about three-fourths had a gastric-only procedure, while the rest had a gastric procedure plus diversion) and 312 patients had medical management. The mean duration of diabetes at baseline was roughly 3.5 years.

After 2 years the proportion of patients achieving diabetes remission, defined as a fasting plasma glucose of less than 5.6 mmol/L in the absence of any antidiabetes medication, was higher in the surgical group than in the medical group (64% vs. 15%, P less than .001). And within the surgical group, it was higher for those whose operation included a diversion (76% vs. 60%, P = .016).

Among the patients who had surgery, the probability of remission fell with increasing baseline diabetes duration (–0.210), and fasting blood glucose level (–0.145), whereas it rose with increasing body mass index (+0.059). But when the type of surgery was added to the model, body mass index was no longer a significant predictor, and two additional predictors emerged: use of only oral antidiabetic medications versus none (–1.22) and receipt of a procedure with diversion (2.180).

In the subgroup who had a gastric-only procedure, the probability of remission fell with increasing diabetes duration (–0.197), and increasing fasting blood glucose level (–0.186), and it was lower for patients who used only oral antidiabetic medications (–1.364) or insulin with or without oral medications (–1.783). In the subgroup who had a gastric procedure with diversion, the only predictor was diabetes duration (–0.273).

Of note, there was no significant difference in the odds of remission between patients with a body mass index of 35 kg/m² or lower and patients with a body index between 35 and 40 kg/m².

Dr. Mingrone disclosed that she receives lecture fees and travel expenses from Novo Nordisk, and research grants from AstraZeneca, and is a consultant to Fractyl.

VANCOUVER – It may be time to reconsider the criteria used to select obese patients with type 2 diabetes mellitus for bariatric surgery, according to data from a pooled cohort study.

Typically, diabetic patients are considered eligible only if they have a body mass index of at least 35 kg/m² and poorly controlled glycemia, according to lead author Dr. Geltrude Mingrone, department of internal medicine, Catholic University, Rome, and department of diabetes and nutritional sciences, King’s College, London.

But in her team’s new analysis of 727 patients, the best predictors of remission after bariatric surgery were a lower fasting glucose level, shorter diabetes duration at baseline, and having a gastric procedure with diversion, she reported at the World Diabetes Congress. And the best baseline predictors of improved glycemic control after bariatric surgery were lower waist circumference, better diabetes control, and lower triglyceride levels.

“We can say that there is a clear advantage of an early operation on diabetes remission that is independent of baseline body mass index. Baseline waist circumference and HOMA-IR [homeostasis model assessment of insulin resistance] are better predictors of glycemic control after bariatric surgery than body mass index,” Dr. Mingrone maintained.

“So I would like to advise the scientific community … to try to define new criteria for the selection of diabetic patients for metabolic surgery. Also, [it is important] because all over the world, the number of bariatric operations is only 250,000, a quarter of a million, while the potential eligible patients are many, many millions,” she concluded.

“I completely concur with Professor Mingrone – we need to come up with criteria for utilizing this procedure,” session comoderator Dr. Robert E. Ratner said in an interview.

“There are so many millions of individuals with diabetes, we cannot be doing surgery on all of them. We need to be selective, and we need to be very specific about why we are doing it and what we are looking for,” elaborated Dr. Rattner, who is a professor of medicine at Georgetown University and senior research scientist at the MedStar Health Research Institute, Washington, as well as chief scientific and medical officer of the American Diabetes Association, Alexandria, Va.

In the new research, the investigators merged databases of the Swedish Obese Subjects (SOS) prospective controlled study (N Engl J Med. 2004;351:2683-93) and two randomized, controlled trials conducted in Australia (JAMA. 2008;299:316-23) and Italy (N Engl J Med. 2012;366:1577-85).

Overall, 415 patients had bariatric surgery (about three-fourths had a gastric-only procedure, while the rest had a gastric procedure plus diversion) and 312 patients had medical management. The mean duration of diabetes at baseline was roughly 3.5 years.

After 2 years the proportion of patients achieving diabetes remission, defined as a fasting plasma glucose of less than 5.6 mmol/L in the absence of any antidiabetes medication, was higher in the surgical group than in the medical group (64% vs. 15%, P less than .001). And within the surgical group, it was higher for those whose operation included a diversion (76% vs. 60%, P = .016).

Among the patients who had surgery, the probability of remission fell with increasing baseline diabetes duration (–0.210), and fasting blood glucose level (–0.145), whereas it rose with increasing body mass index (+0.059). But when the type of surgery was added to the model, body mass index was no longer a significant predictor, and two additional predictors emerged: use of only oral antidiabetic medications versus none (–1.22) and receipt of a procedure with diversion (2.180).

In the subgroup who had a gastric-only procedure, the probability of remission fell with increasing diabetes duration (–0.197), and increasing fasting blood glucose level (–0.186), and it was lower for patients who used only oral antidiabetic medications (–1.364) or insulin with or without oral medications (–1.783). In the subgroup who had a gastric procedure with diversion, the only predictor was diabetes duration (–0.273).

Of note, there was no significant difference in the odds of remission between patients with a body mass index of 35 kg/m² or lower and patients with a body index between 35 and 40 kg/m².

Dr. Mingrone disclosed that she receives lecture fees and travel expenses from Novo Nordisk, and research grants from AstraZeneca, and is a consultant to Fractyl.

VANCOUVER – Perhaps in the not-too-distant future, people at risk for type 1 diabetes will be screened for antibodies against beta cells, and, if two or more are present, started on immunotherapy to prevent beta cell destruction and clinical disease.

The vision is to treat “islet autoimmunity” as we do hypertension and other silent diseases to prevent problems down the road.

In the everyday medical world, that’s mostly science fiction for now – treatment starts when symptoms emerge – but researchers around the world are working hard to make it a reality, including Dr. Carla J. Greenbaum, director of the Diabetes Research Program at the Benaroya Research Institute in Seattle.

It’s known now that when babies have two or more antibodies against beta cells, about 11% per year will develop clinical diabetes, and all of them eventually. Adults with two or more antibodies will also develop diabetes, although at a slower rate than children.

“The take-home message is that type 1 diabetes starts when you have two antibodies. We need to change from symptom management to disease-modifying therapy, and that will require immunotherapy; it will be the future of diabetes care. Endocrinologists need to learn about immunotherapy,” Dr. Greenbaum said at the World Diabetes Congress.

So far, studies of four immunotherapies – teplizumab (Diabetes. 2013 Nov;62[11]:3766-74), rituximab (N Engl J Med. 2009 Nov 26;361[22]:2143-52), abatacept (Diabetes Care. 2014 Apr;37[4]:1069-75), and, most recently, alefacept (J Clin Invest. 2015 Aug 3;125[8]:3285-96) – have shown positive outcomes in preserving beta cell function after diagnosis of type 1. “The positive results are largely driven by children,” she said, suggesting that they might benefit most from a screen-and-treat approach to islet autoimmunity.

Teplizumab, oral insulin, and abatacept are now being tested in antibody-positive patients who haven’t developed symptoms. The trials aim to reduce the risk of clinical disease by 40%. If successful, treating 100 people with islet autoimmunity would prevent 14 from getting clinical type 1 diabetes, said Dr. Greenbaum, who is involved in the work.

A lot of questions need to be answered if the results pan out. Who should be screened, for instance, and how, and what immunotherapies should be used in different patient groups? What’s the right balance between risks and benefits?

There’s also a big question about how to “bring disease-modifying therapies to the clinic. As endocrinologists, we don’t use immunotherapies, but it’s important to recognize that millions of people for many decades have been using them safely to change the course of disease. We need to learn how to do this,” Dr. Greenbaum said.

“I often get people saying immunotherapy doesn’t really work, but that’s not true.” The effect sizes are small – maybe 20% – but it’s the same case in multiple sclerosis and rheumatoid arthritis. “The issue is if you have a weak joint, and you are 20% better, you feel it, but if beta cells are doing better, you might not notice,” she said.

Dr. Greenbaum disclosed research support from Novo Nordisk.

[email protected]

VANCOUVER – Perhaps in the not-too-distant future, people at risk for type 1 diabetes will be screened for antibodies against beta cells, and, if two or more are present, started on immunotherapy to prevent beta cell destruction and clinical disease.

The vision is to treat “islet autoimmunity” as we do hypertension and other silent diseases to prevent problems down the road.

In the everyday medical world, that’s mostly science fiction for now – treatment starts when symptoms emerge – but researchers around the world are working hard to make it a reality, including Dr. Carla J. Greenbaum, director of the Diabetes Research Program at the Benaroya Research Institute in Seattle.

It’s known now that when babies have two or more antibodies against beta cells, about 11% per year will develop clinical diabetes, and all of them eventually. Adults with two or more antibodies will also develop diabetes, although at a slower rate than children.

“The take-home message is that type 1 diabetes starts when you have two antibodies. We need to change from symptom management to disease-modifying therapy, and that will require immunotherapy; it will be the future of diabetes care. Endocrinologists need to learn about immunotherapy,” Dr. Greenbaum said at the World Diabetes Congress.

So far, studies of four immunotherapies – teplizumab (Diabetes. 2013 Nov;62[11]:3766-74), rituximab (N Engl J Med. 2009 Nov 26;361[22]:2143-52), abatacept (Diabetes Care. 2014 Apr;37[4]:1069-75), and, most recently, alefacept (J Clin Invest. 2015 Aug 3;125[8]:3285-96) – have shown positive outcomes in preserving beta cell function after diagnosis of type 1. “The positive results are largely driven by children,” she said, suggesting that they might benefit most from a screen-and-treat approach to islet autoimmunity.

Teplizumab, oral insulin, and abatacept are now being tested in antibody-positive patients who haven’t developed symptoms. The trials aim to reduce the risk of clinical disease by 40%. If successful, treating 100 people with islet autoimmunity would prevent 14 from getting clinical type 1 diabetes, said Dr. Greenbaum, who is involved in the work.

A lot of questions need to be answered if the results pan out. Who should be screened, for instance, and how, and what immunotherapies should be used in different patient groups? What’s the right balance between risks and benefits?

There’s also a big question about how to “bring disease-modifying therapies to the clinic. As endocrinologists, we don’t use immunotherapies, but it’s important to recognize that millions of people for many decades have been using them safely to change the course of disease. We need to learn how to do this,” Dr. Greenbaum said.

“I often get people saying immunotherapy doesn’t really work, but that’s not true.” The effect sizes are small – maybe 20% – but it’s the same case in multiple sclerosis and rheumatoid arthritis. “The issue is if you have a weak joint, and you are 20% better, you feel it, but if beta cells are doing better, you might not notice,” she said.

Dr. Greenbaum disclosed research support from Novo Nordisk.

[email protected]

VANCOUVER – Perhaps in the not-too-distant future, people at risk for type 1 diabetes will be screened for antibodies against beta cells, and, if two or more are present, started on immunotherapy to prevent beta cell destruction and clinical disease.

The vision is to treat “islet autoimmunity” as we do hypertension and other silent diseases to prevent problems down the road.

In the everyday medical world, that’s mostly science fiction for now – treatment starts when symptoms emerge – but researchers around the world are working hard to make it a reality, including Dr. Carla J. Greenbaum, director of the Diabetes Research Program at the Benaroya Research Institute in Seattle.

It’s known now that when babies have two or more antibodies against beta cells, about 11% per year will develop clinical diabetes, and all of them eventually. Adults with two or more antibodies will also develop diabetes, although at a slower rate than children.

“The take-home message is that type 1 diabetes starts when you have two antibodies. We need to change from symptom management to disease-modifying therapy, and that will require immunotherapy; it will be the future of diabetes care. Endocrinologists need to learn about immunotherapy,” Dr. Greenbaum said at the World Diabetes Congress.

So far, studies of four immunotherapies – teplizumab (Diabetes. 2013 Nov;62[11]:3766-74), rituximab (N Engl J Med. 2009 Nov 26;361[22]:2143-52), abatacept (Diabetes Care. 2014 Apr;37[4]:1069-75), and, most recently, alefacept (J Clin Invest. 2015 Aug 3;125[8]:3285-96) – have shown positive outcomes in preserving beta cell function after diagnosis of type 1. “The positive results are largely driven by children,” she said, suggesting that they might benefit most from a screen-and-treat approach to islet autoimmunity.

Teplizumab, oral insulin, and abatacept are now being tested in antibody-positive patients who haven’t developed symptoms. The trials aim to reduce the risk of clinical disease by 40%. If successful, treating 100 people with islet autoimmunity would prevent 14 from getting clinical type 1 diabetes, said Dr. Greenbaum, who is involved in the work.

A lot of questions need to be answered if the results pan out. Who should be screened, for instance, and how, and what immunotherapies should be used in different patient groups? What’s the right balance between risks and benefits?

There’s also a big question about how to “bring disease-modifying therapies to the clinic. As endocrinologists, we don’t use immunotherapies, but it’s important to recognize that millions of people for many decades have been using them safely to change the course of disease. We need to learn how to do this,” Dr. Greenbaum said.

“I often get people saying immunotherapy doesn’t really work, but that’s not true.” The effect sizes are small – maybe 20% – but it’s the same case in multiple sclerosis and rheumatoid arthritis. “The issue is if you have a weak joint, and you are 20% better, you feel it, but if beta cells are doing better, you might not notice,” she said.

Dr. Greenbaum disclosed research support from Novo Nordisk.

[email protected]

VANCOUVER – Taking frequent 5-minute breaks from prolonged sitting to stand or walk at a leisurely pace improved the metabolic response to a meal in heavy postmenopausal women with dysglycemia in a randomized trial reported at the World Diabetes Congress.

The incremental area under the curve for glucose levels after a meal was 34% lower with standing breaks and 28% lower with light walking breaks, compared with uninterrupted, prolonged sitting. Moreover, these benefits persisted into the next day.

Findings were similar for levels of insulin (20% and 37% reductions in response) and for the suppression of nonesterified fatty acids (33% and 47% reductions in response).

“The results of this trial provide new experimental evidence that simply breaking up sedentary behavior appears to have quite an acute positive effect in overweight or obese women with a high risk of type 2 diabetes, and it may last for at least 24 hours after the initial activity stimulus,” commented first author Joseph Henson, Ph.D., a research associate at the Diabetes Research Centre at the University of Leicester in England.

“This simple behavioral approach could inform future public health interventions aimed at improving the metabolic profile of dysglycemic individuals if we are able to prove this in large numbers and also in men,” he added.

“I think as a proof of principle, this study was fascinating,” commented session comoderator Dr. Robert E. Ratner, professor of medicine at Georgetown University and senior research scientist at the MedStar Health Research Institute, Washington, as well as chief scientific and medical officer of the American Diabetes Association.

However, the uninterrupted sitting condition was not realistic, he noted in an interview. “The bottom line is that none of us are escorted to the lavatory by wheelchairs, so the control situation is somewhat limited. But I think that it points out that all of us need to sit less and move more.”

A session attendee noted that the findings for simple standing and with regard to the persistence of the effects over time were somewhat surprising.

The “difference I would have thought previously would have been driven by energy expenditure. So I would have said individuals would have to get up and move in order to see a difference,” Dr. Henson acknowledged. “But we were noticing that [benefit] even with standing. So maybe there is something happening at the level of the muscle, which is inducing the responses.”

As for the persistence of the metabolic benefit, more research will be needed, he said. In particular, studies should assess exactly how long it lasts.

“I think the main conclusion is, simply put, that you can break sitting time with anything, whether it’s standing or walking, and you are likely to get some sort of effect,” Dr. Henson said. Also, individuals should “try and use a stepped approach, so going from sitting to standing, and from standing to walking. The more you move, the better the health outcomes will be.”

Women were eligible for the trial if they were overweight or obese, postmenopausal, aged 50-75 years, and had impaired glucose tolerance or a glycated hemoglobin level of 5.7%-6.4%. “These characteristics are really important because these are the sorts of individuals who are likely to be identified and referred into relevant diabetes prevention programs,” Dr. Henson commented. In addition, the women had to be sedentary, engaging in less than 150 minutes of regular purposeful activity each week.

They each participated in two of three activities on separate days: unbroken prolonged sitting for 7.5 hours (interrupted only by trips to the restroom by wheelchair); prolonged sitting, broken up with 5-minute bouts of standing every 30 minutes; and prolonged sitting, broken up with 5-minute bouts of light-intensity walking (up to 2.5 mph) on a treadmill every 30 minutes.

Midway through each day, the women were given a high-fat meal. Serial blood samples were collected throughout the day for measurement of cardiometabolic markers.

Study results, reported at the congress and recently published (Diabetes Care. 2015 Dec 1. doi: 10.2337/dc15-1240), showed that the incremental area under the curve was 5.3 mmol/L per hour with unbroken prolonged sitting, but it was lower at 3.5 mmol/L per hour with standing breaks and 3.8 mmol/L per hour with sitting breaks (P less than .05 for each difference vs. sitting).

Respective values were 548.2, 437.2, and 347.9 mU/L per hour for insulin levels (P less than .05 for each difference vs. sitting), and –1.5, –1.0, and –0.8 mmol/L per hour for suppression of nonesterified fatty acid levels (P less than .05 for each difference vs. sitting).

In contrast, neither type of activity break significantly affected the triglyceride response to a meal or altered blood pressure, according to Dr. Henson, who disclosed that he received support for the presentation from the International Diabetes Federation–American Diabetes Association.

VANCOUVER – Taking frequent 5-minute breaks from prolonged sitting to stand or walk at a leisurely pace improved the metabolic response to a meal in heavy postmenopausal women with dysglycemia in a randomized trial reported at the World Diabetes Congress.

The incremental area under the curve for glucose levels after a meal was 34% lower with standing breaks and 28% lower with light walking breaks, compared with uninterrupted, prolonged sitting. Moreover, these benefits persisted into the next day.

Findings were similar for levels of insulin (20% and 37% reductions in response) and for the suppression of nonesterified fatty acids (33% and 47% reductions in response).

“The results of this trial provide new experimental evidence that simply breaking up sedentary behavior appears to have quite an acute positive effect in overweight or obese women with a high risk of type 2 diabetes, and it may last for at least 24 hours after the initial activity stimulus,” commented first author Joseph Henson, Ph.D., a research associate at the Diabetes Research Centre at the University of Leicester in England.

“This simple behavioral approach could inform future public health interventions aimed at improving the metabolic profile of dysglycemic individuals if we are able to prove this in large numbers and also in men,” he added.

“I think as a proof of principle, this study was fascinating,” commented session comoderator Dr. Robert E. Ratner, professor of medicine at Georgetown University and senior research scientist at the MedStar Health Research Institute, Washington, as well as chief scientific and medical officer of the American Diabetes Association.

However, the uninterrupted sitting condition was not realistic, he noted in an interview. “The bottom line is that none of us are escorted to the lavatory by wheelchairs, so the control situation is somewhat limited. But I think that it points out that all of us need to sit less and move more.”

A session attendee noted that the findings for simple standing and with regard to the persistence of the effects over time were somewhat surprising.

The “difference I would have thought previously would have been driven by energy expenditure. So I would have said individuals would have to get up and move in order to see a difference,” Dr. Henson acknowledged. “But we were noticing that [benefit] even with standing. So maybe there is something happening at the level of the muscle, which is inducing the responses.”

As for the persistence of the metabolic benefit, more research will be needed, he said. In particular, studies should assess exactly how long it lasts.

“I think the main conclusion is, simply put, that you can break sitting time with anything, whether it’s standing or walking, and you are likely to get some sort of effect,” Dr. Henson said. Also, individuals should “try and use a stepped approach, so going from sitting to standing, and from standing to walking. The more you move, the better the health outcomes will be.”

Women were eligible for the trial if they were overweight or obese, postmenopausal, aged 50-75 years, and had impaired glucose tolerance or a glycated hemoglobin level of 5.7%-6.4%. “These characteristics are really important because these are the sorts of individuals who are likely to be identified and referred into relevant diabetes prevention programs,” Dr. Henson commented. In addition, the women had to be sedentary, engaging in less than 150 minutes of regular purposeful activity each week.

They each participated in two of three activities on separate days: unbroken prolonged sitting for 7.5 hours (interrupted only by trips to the restroom by wheelchair); prolonged sitting, broken up with 5-minute bouts of standing every 30 minutes; and prolonged sitting, broken up with 5-minute bouts of light-intensity walking (up to 2.5 mph) on a treadmill every 30 minutes.

Midway through each day, the women were given a high-fat meal. Serial blood samples were collected throughout the day for measurement of cardiometabolic markers.

Study results, reported at the congress and recently published (Diabetes Care. 2015 Dec 1. doi: 10.2337/dc15-1240), showed that the incremental area under the curve was 5.3 mmol/L per hour with unbroken prolonged sitting, but it was lower at 3.5 mmol/L per hour with standing breaks and 3.8 mmol/L per hour with sitting breaks (P less than .05 for each difference vs. sitting).

Respective values were 548.2, 437.2, and 347.9 mU/L per hour for insulin levels (P less than .05 for each difference vs. sitting), and –1.5, –1.0, and –0.8 mmol/L per hour for suppression of nonesterified fatty acid levels (P less than .05 for each difference vs. sitting).

In contrast, neither type of activity break significantly affected the triglyceride response to a meal or altered blood pressure, according to Dr. Henson, who disclosed that he received support for the presentation from the International Diabetes Federation–American Diabetes Association.

VANCOUVER – Taking frequent 5-minute breaks from prolonged sitting to stand or walk at a leisurely pace improved the metabolic response to a meal in heavy postmenopausal women with dysglycemia in a randomized trial reported at the World Diabetes Congress.

The incremental area under the curve for glucose levels after a meal was 34% lower with standing breaks and 28% lower with light walking breaks, compared with uninterrupted, prolonged sitting. Moreover, these benefits persisted into the next day.

Findings were similar for levels of insulin (20% and 37% reductions in response) and for the suppression of nonesterified fatty acids (33% and 47% reductions in response).

“The results of this trial provide new experimental evidence that simply breaking up sedentary behavior appears to have quite an acute positive effect in overweight or obese women with a high risk of type 2 diabetes, and it may last for at least 24 hours after the initial activity stimulus,” commented first author Joseph Henson, Ph.D., a research associate at the Diabetes Research Centre at the University of Leicester in England.

“This simple behavioral approach could inform future public health interventions aimed at improving the metabolic profile of dysglycemic individuals if we are able to prove this in large numbers and also in men,” he added.

“I think as a proof of principle, this study was fascinating,” commented session comoderator Dr. Robert E. Ratner, professor of medicine at Georgetown University and senior research scientist at the MedStar Health Research Institute, Washington, as well as chief scientific and medical officer of the American Diabetes Association.

However, the uninterrupted sitting condition was not realistic, he noted in an interview. “The bottom line is that none of us are escorted to the lavatory by wheelchairs, so the control situation is somewhat limited. But I think that it points out that all of us need to sit less and move more.”

A session attendee noted that the findings for simple standing and with regard to the persistence of the effects over time were somewhat surprising.

The “difference I would have thought previously would have been driven by energy expenditure. So I would have said individuals would have to get up and move in order to see a difference,” Dr. Henson acknowledged. “But we were noticing that [benefit] even with standing. So maybe there is something happening at the level of the muscle, which is inducing the responses.”

As for the persistence of the metabolic benefit, more research will be needed, he said. In particular, studies should assess exactly how long it lasts.

“I think the main conclusion is, simply put, that you can break sitting time with anything, whether it’s standing or walking, and you are likely to get some sort of effect,” Dr. Henson said. Also, individuals should “try and use a stepped approach, so going from sitting to standing, and from standing to walking. The more you move, the better the health outcomes will be.”

Women were eligible for the trial if they were overweight or obese, postmenopausal, aged 50-75 years, and had impaired glucose tolerance or a glycated hemoglobin level of 5.7%-6.4%. “These characteristics are really important because these are the sorts of individuals who are likely to be identified and referred into relevant diabetes prevention programs,” Dr. Henson commented. In addition, the women had to be sedentary, engaging in less than 150 minutes of regular purposeful activity each week.

They each participated in two of three activities on separate days: unbroken prolonged sitting for 7.5 hours (interrupted only by trips to the restroom by wheelchair); prolonged sitting, broken up with 5-minute bouts of standing every 30 minutes; and prolonged sitting, broken up with 5-minute bouts of light-intensity walking (up to 2.5 mph) on a treadmill every 30 minutes.

Midway through each day, the women were given a high-fat meal. Serial blood samples were collected throughout the day for measurement of cardiometabolic markers.

Study results, reported at the congress and recently published (Diabetes Care. 2015 Dec 1. doi: 10.2337/dc15-1240), showed that the incremental area under the curve was 5.3 mmol/L per hour with unbroken prolonged sitting, but it was lower at 3.5 mmol/L per hour with standing breaks and 3.8 mmol/L per hour with sitting breaks (P less than .05 for each difference vs. sitting).

Respective values were 548.2, 437.2, and 347.9 mU/L per hour for insulin levels (P less than .05 for each difference vs. sitting), and –1.5, –1.0, and –0.8 mmol/L per hour for suppression of nonesterified fatty acid levels (P less than .05 for each difference vs. sitting).

In contrast, neither type of activity break significantly affected the triglyceride response to a meal or altered blood pressure, according to Dr. Henson, who disclosed that he received support for the presentation from the International Diabetes Federation–American Diabetes Association.

VANCOUVER – Taking frequent 5-minute breaks from prolonged sitting to stand or walk at a leisurely pace improved the metabolic response to a meal in heavy postmenopausal women with dysglycemia in a randomized trial reported at the World Diabetes Congress.

The incremental area under the curve for glucose levels after a meal was 34% lower with standing breaks and 28% lower with light walking breaks, compared with uninterrupted, prolonged sitting. Moreover, these benefits persisted into the next day.

Findings were similar for levels of insulin (20% and 37% reductions in response) and for the suppression of nonesterified fatty acids (33% and 47% reductions in response).

“The results of this trial provide new experimental evidence that simply breaking up sedentary behavior appears to have quite an acute positive effect in overweight or obese women with a high risk of type 2 diabetes, and it may last for at least 24 hours after the initial activity stimulus,” commented first author Joseph Henson, Ph.D., a research associate at the Diabetes Research Centre at the University of Leicester in England.

“This simple behavioral approach could inform future public health interventions aimed at improving the metabolic profile of dysglycemic individuals if we are able to prove this in large numbers and also in men,” he added.

“I think as a proof of principle, this study was fascinating,” commented session comoderator Dr. Robert E. Ratner, professor of medicine at Georgetown University and senior research scientist at the MedStar Health Research Institute, Washington, as well as chief scientific and medical officer of the American Diabetes Association.

However, the uninterrupted sitting condition was not realistic, he noted in an interview. “The bottom line is that none of us are escorted to the lavatory by wheelchairs, so the control situation is somewhat limited. But I think that it points out that all of us need to sit less and move more.”

A session attendee noted that the findings for simple standing and with regard to the persistence of the effects over time were somewhat surprising.

The “difference I would have thought previously would have been driven by energy expenditure. So I would have said individuals would have to get up and move in order to see a difference,” Dr. Henson acknowledged. “But we were noticing that [benefit] even with standing. So maybe there is something happening at the level of the muscle, which is inducing the responses.”

As for the persistence of the metabolic benefit, more research will be needed, he said. In particular, studies should assess exactly how long it lasts.

“I think the main conclusion is, simply put, that you can break sitting time with anything, whether it’s standing or walking, and you are likely to get some sort of effect,” Dr. Henson said. Also, individuals should “try and use a stepped approach, so going from sitting to standing, and from standing to walking. The more you move, the better the health outcomes will be.”

Women were eligible for the trial if they were overweight or obese, postmenopausal, aged 50-75 years, and had impaired glucose tolerance or a glycated hemoglobin level of 5.7%-6.4%. “These characteristics are really important because these are the sorts of individuals who are likely to be identified and referred into relevant diabetes prevention programs,” Dr. Henson commented. In addition, the women had to be sedentary, engaging in less than 150 minutes of regular purposeful activity each week.

They each participated in two of three activities on separate days: unbroken prolonged sitting for 7.5 hours (interrupted only by trips to the restroom by wheelchair); prolonged sitting, broken up with 5-minute bouts of standing every 30 minutes; and prolonged sitting, broken up with 5-minute bouts of light-intensity walking (up to 2.5 mph) on a treadmill every 30 minutes.

Midway through each day, the women were given a high-fat meal. Serial blood samples were collected throughout the day for measurement of cardiometabolic markers.

Study results, reported at the congress and recently published (Diabetes Care. 2015 Dec 1. doi: 10.2337/dc15-1240), showed that the incremental area under the curve was 5.3 mmol/L per hour with unbroken prolonged sitting, but it was lower at 3.5 mmol/L per hour with standing breaks and 3.8 mmol/L per hour with sitting breaks (P less than .05 for each difference vs. sitting).

Respective values were 548.2, 437.2, and 347.9 mU/L per hour for insulin levels (P less than .05 for each difference vs. sitting), and –1.5, –1.0, and –0.8 mmol/L per hour for suppression of nonesterified fatty acid levels (P less than .05 for each difference vs. sitting).

In contrast, neither type of activity break significantly affected the triglyceride response to a meal or altered blood pressure, according to Dr. Henson, who disclosed that he received support for the presentation from the International Diabetes Federation–American Diabetes Association.

[email protected]

VANCOUVER – Taking frequent 5-minute breaks from prolonged sitting to stand or walk at a leisurely pace improved the metabolic response to a meal in heavy postmenopausal women with dysglycemia in a randomized trial reported at the World Diabetes Congress.

The incremental area under the curve for glucose levels after a meal was 34% lower with standing breaks and 28% lower with light walking breaks, compared with uninterrupted, prolonged sitting. Moreover, these benefits persisted into the next day.

Findings were similar for levels of insulin (20% and 37% reductions in response) and for the suppression of nonesterified fatty acids (33% and 47% reductions in response).

“The results of this trial provide new experimental evidence that simply breaking up sedentary behavior appears to have quite an acute positive effect in overweight or obese women with a high risk of type 2 diabetes, and it may last for at least 24 hours after the initial activity stimulus,” commented first author Joseph Henson, Ph.D., a research associate at the Diabetes Research Centre at the University of Leicester in England.

“This simple behavioral approach could inform future public health interventions aimed at improving the metabolic profile of dysglycemic individuals if we are able to prove this in large numbers and also in men,” he added.

“I think as a proof of principle, this study was fascinating,” commented session comoderator Dr. Robert E. Ratner, professor of medicine at Georgetown University and senior research scientist at the MedStar Health Research Institute, Washington, as well as chief scientific and medical officer of the American Diabetes Association.

However, the uninterrupted sitting condition was not realistic, he noted in an interview. “The bottom line is that none of us are escorted to the lavatory by wheelchairs, so the control situation is somewhat limited. But I think that it points out that all of us need to sit less and move more.”

A session attendee noted that the findings for simple standing and with regard to the persistence of the effects over time were somewhat surprising.

The “difference I would have thought previously would have been driven by energy expenditure. So I would have said individuals would have to get up and move in order to see a difference,” Dr. Henson acknowledged. “But we were noticing that [benefit] even with standing. So maybe there is something happening at the level of the muscle, which is inducing the responses.”

As for the persistence of the metabolic benefit, more research will be needed, he said. In particular, studies should assess exactly how long it lasts.

“I think the main conclusion is, simply put, that you can break sitting time with anything, whether it’s standing or walking, and you are likely to get some sort of effect,” Dr. Henson said. Also, individuals should “try and use a stepped approach, so going from sitting to standing, and from standing to walking. The more you move, the better the health outcomes will be.”

Women were eligible for the trial if they were overweight or obese, postmenopausal, aged 50-75 years, and had impaired glucose tolerance or a glycated hemoglobin level of 5.7%-6.4%. “These characteristics are really important because these are the sorts of individuals who are likely to be identified and referred into relevant diabetes prevention programs,” Dr. Henson commented. In addition, the women had to be sedentary, engaging in less than 150 minutes of regular purposeful activity each week.

They each participated in two of three activities on separate days: unbroken prolonged sitting for 7.5 hours (interrupted only by trips to the restroom by wheelchair); prolonged sitting, broken up with 5-minute bouts of standing every 30 minutes; and prolonged sitting, broken up with 5-minute bouts of light-intensity walking (up to 2.5 mph) on a treadmill every 30 minutes.

Midway through each day, the women were given a high-fat meal. Serial blood samples were collected throughout the day for measurement of cardiometabolic markers.

Study results, reported at the congress and recently published (Diabetes Care. 2015 Dec 1. doi: 10.2337/dc15-1240), showed that the incremental area under the curve was 5.3 mmol/L per hour with unbroken prolonged sitting, but it was lower at 3.5 mmol/L per hour with standing breaks and 3.8 mmol/L per hour with sitting breaks (P less than .05 for each difference vs. sitting).

Respective values were 548.2, 437.2, and 347.9 mU/L per hour for insulin levels (P less than .05 for each difference vs. sitting), and –1.5, –1.0, and –0.8 mmol/L per hour for suppression of nonesterified fatty acid levels (P less than .05 for each difference vs. sitting).

In contrast, neither type of activity break significantly affected the triglyceride response to a meal or altered blood pressure, according to Dr. Henson, who disclosed that he received support for the presentation from the International Diabetes Federation–American Diabetes Association.

[email protected]

VANCOUVER – Taking frequent 5-minute breaks from prolonged sitting to stand or walk at a leisurely pace improved the metabolic response to a meal in heavy postmenopausal women with dysglycemia in a randomized trial reported at the World Diabetes Congress.

The incremental area under the curve for glucose levels after a meal was 34% lower with standing breaks and 28% lower with light walking breaks, compared with uninterrupted, prolonged sitting. Moreover, these benefits persisted into the next day.

Findings were similar for levels of insulin (20% and 37% reductions in response) and for the suppression of nonesterified fatty acids (33% and 47% reductions in response).

“The results of this trial provide new experimental evidence that simply breaking up sedentary behavior appears to have quite an acute positive effect in overweight or obese women with a high risk of type 2 diabetes, and it may last for at least 24 hours after the initial activity stimulus,” commented first author Joseph Henson, Ph.D., a research associate at the Diabetes Research Centre at the University of Leicester in England.

“This simple behavioral approach could inform future public health interventions aimed at improving the metabolic profile of dysglycemic individuals if we are able to prove this in large numbers and also in men,” he added.

“I think as a proof of principle, this study was fascinating,” commented session comoderator Dr. Robert E. Ratner, professor of medicine at Georgetown University and senior research scientist at the MedStar Health Research Institute, Washington, as well as chief scientific and medical officer of the American Diabetes Association.

However, the uninterrupted sitting condition was not realistic, he noted in an interview. “The bottom line is that none of us are escorted to the lavatory by wheelchairs, so the control situation is somewhat limited. But I think that it points out that all of us need to sit less and move more.”

A session attendee noted that the findings for simple standing and with regard to the persistence of the effects over time were somewhat surprising.

The “difference I would have thought previously would have been driven by energy expenditure. So I would have said individuals would have to get up and move in order to see a difference,” Dr. Henson acknowledged. “But we were noticing that [benefit] even with standing. So maybe there is something happening at the level of the muscle, which is inducing the responses.”

As for the persistence of the metabolic benefit, more research will be needed, he said. In particular, studies should assess exactly how long it lasts.

“I think the main conclusion is, simply put, that you can break sitting time with anything, whether it’s standing or walking, and you are likely to get some sort of effect,” Dr. Henson said. Also, individuals should “try and use a stepped approach, so going from sitting to standing, and from standing to walking. The more you move, the better the health outcomes will be.”

Women were eligible for the trial if they were overweight or obese, postmenopausal, aged 50-75 years, and had impaired glucose tolerance or a glycated hemoglobin level of 5.7%-6.4%. “These characteristics are really important because these are the sorts of individuals who are likely to be identified and referred into relevant diabetes prevention programs,” Dr. Henson commented. In addition, the women had to be sedentary, engaging in less than 150 minutes of regular purposeful activity each week.

They each participated in two of three activities on separate days: unbroken prolonged sitting for 7.5 hours (interrupted only by trips to the restroom by wheelchair); prolonged sitting, broken up with 5-minute bouts of standing every 30 minutes; and prolonged sitting, broken up with 5-minute bouts of light-intensity walking (up to 2.5 mph) on a treadmill every 30 minutes.

Midway through each day, the women were given a high-fat meal. Serial blood samples were collected throughout the day for measurement of cardiometabolic markers.

Study results, reported at the congress and recently published (Diabetes Care. 2015 Dec 1. doi: 10.2337/dc15-1240), showed that the incremental area under the curve was 5.3 mmol/L per hour with unbroken prolonged sitting, but it was lower at 3.5 mmol/L per hour with standing breaks and 3.8 mmol/L per hour with sitting breaks (P less than .05 for each difference vs. sitting).

Respective values were 548.2, 437.2, and 347.9 mU/L per hour for insulin levels (P less than .05 for each difference vs. sitting), and –1.5, –1.0, and –0.8 mmol/L per hour for suppression of nonesterified fatty acid levels (P less than .05 for each difference vs. sitting).

In contrast, neither type of activity break significantly affected the triglyceride response to a meal or altered blood pressure, according to Dr. Henson, who disclosed that he received support for the presentation from the International Diabetes Federation–American Diabetes Association.

[email protected]

VANCOUVER – When diabetes is diagnosed from ages 15 to 30 years, type 2 patients are less likely than are type 1 patients to reach their 50th birthday, according to investigators from the University of Sydney.

Even just a few years after diagnosis, young type 2 patients have a worse cardiovascular profile and worse cardiovascular disease, which leads to an earlier death.

“We pay less attention to type 2 than type 1 in young people. They’re not as sick, and don’t develop [diabetic ketoacidosis] if they miss a treatment. But young type 2 is not a milder form of diabetes in young people, and its detrimental impact occurs early. Before we know what’s going on, patients are middle age, and it’s too late,” said investigator Maria Constantino, a Ph.D. candidate, nurse, and diabetes researcher and educator at the University of Sydney.

Screening for type 2 diabetes “should start at a young age in at-risk groups,” and diabetes cardiovascular risk criteria should be reconsidered so that younger type 2 patients aren’t overlooked because of their age. Current criteria likely “lead to delay in preventive treatment” in the young, she said.

The conclusions come from a review of diabetes patients treated since 1990 at the Royal Prince Alfred Hospital in Sydney (Diabetes Care. 2013 Dec; 36[12]:3863-9).

The investigators compared 354 type 2 patients with 470 type 1 patients diagnosed from age 15-30 years. By around the age of 40 years, 11% of the type 2 patients had died, vs. 6.8% with type 1 (hazard ratio, 2.0; 95% confidence interval, 1.2-3.2; P = .003). Strokes, coronary artery disease, and other macrovascular complications were also far more common in the type 2 group, and they had worse hypertension and dyslipidemia despite taking more drugs to combat both. Type 2 patients also had more albuminuria and neuropathy.

The differences occurred despite the fact that type 2 patients smoked less, had a slightly shorter duration of disease (11.6 vs. 14.7 years), and equivalent glycemic control with their type 1 counterparts, with a mean hemoglobin A_1c of 8.1% in both groups. They were heavier, however, with a mean body mass index of 32.2 kg/m² vs. 25.6 kg/m² in type 1 patients.

In short, young-onset type 2 is a “more lethal phenotype of diabetes. We are not saying one type of diabetes is more important; we need to conquer both.” But in young type 2 patients, “we need to focus on more than just glycemic control.” Cardiovascular risk factors are “detectable early, and treatable,” Ms. Constantino said.

The investigators also compared their 354 young-onset type 2 patients with 1,062 patients diagnosed from age 40-50 years.

By the time they were about 50 years old, young-onset patients were 6.5 times more likely to have died than were their age-matched peers without diabetes in the general Australian population. The peak in excess mortality for those diagnosed in their 5th decade came at about age of 65 years, with a risk of death about 2.5 times higher than nondiabetic peers in the general population.

“The impact of type 2 is much higher the younger a person is. You can argue that in our enthusiasm to diagnose diabetes, we are casting our screening net wider and wider, and take pride in diagnosing many elderly patients with diabetes, but we should not lose sight of the fact that finding and treating an elderly person with diabetes has much less impact than finding and treating one in a young age group,” she said.

Ms. Constantino has no conflicts of interest.

[email protected]

VANCOUVER – When diabetes is diagnosed from ages 15 to 30 years, type 2 patients are less likely than are type 1 patients to reach their 50th birthday, according to investigators from the University of Sydney.

Even just a few years after diagnosis, young type 2 patients have a worse cardiovascular profile and worse cardiovascular disease, which leads to an earlier death.

“We pay less attention to type 2 than type 1 in young people. They’re not as sick, and don’t develop [diabetic ketoacidosis] if they miss a treatment. But young type 2 is not a milder form of diabetes in young people, and its detrimental impact occurs early. Before we know what’s going on, patients are middle age, and it’s too late,” said investigator Maria Constantino, a Ph.D. candidate, nurse, and diabetes researcher and educator at the University of Sydney.

Screening for type 2 diabetes “should start at a young age in at-risk groups,” and diabetes cardiovascular risk criteria should be reconsidered so that younger type 2 patients aren’t overlooked because of their age. Current criteria likely “lead to delay in preventive treatment” in the young, she said.

The conclusions come from a review of diabetes patients treated since 1990 at the Royal Prince Alfred Hospital in Sydney (Diabetes Care. 2013 Dec; 36[12]:3863-9).

The investigators compared 354 type 2 patients with 470 type 1 patients diagnosed from age 15-30 years. By around the age of 40 years, 11% of the type 2 patients had died, vs. 6.8% with type 1 (hazard ratio, 2.0; 95% confidence interval, 1.2-3.2; P = .003). Strokes, coronary artery disease, and other macrovascular complications were also far more common in the type 2 group, and they had worse hypertension and dyslipidemia despite taking more drugs to combat both. Type 2 patients also had more albuminuria and neuropathy.

The differences occurred despite the fact that type 2 patients smoked less, had a slightly shorter duration of disease (11.6 vs. 14.7 years), and equivalent glycemic control with their type 1 counterparts, with a mean hemoglobin A_1c of 8.1% in both groups. They were heavier, however, with a mean body mass index of 32.2 kg/m² vs. 25.6 kg/m² in type 1 patients.

In short, young-onset type 2 is a “more lethal phenotype of diabetes. We are not saying one type of diabetes is more important; we need to conquer both.” But in young type 2 patients, “we need to focus on more than just glycemic control.” Cardiovascular risk factors are “detectable early, and treatable,” Ms. Constantino said.

The investigators also compared their 354 young-onset type 2 patients with 1,062 patients diagnosed from age 40-50 years.

By the time they were about 50 years old, young-onset patients were 6.5 times more likely to have died than were their age-matched peers without diabetes in the general Australian population. The peak in excess mortality for those diagnosed in their 5th decade came at about age of 65 years, with a risk of death about 2.5 times higher than nondiabetic peers in the general population.

“The impact of type 2 is much higher the younger a person is. You can argue that in our enthusiasm to diagnose diabetes, we are casting our screening net wider and wider, and take pride in diagnosing many elderly patients with diabetes, but we should not lose sight of the fact that finding and treating an elderly person with diabetes has much less impact than finding and treating one in a young age group,” she said.

Ms. Constantino has no conflicts of interest.

[email protected]

VANCOUVER – When diabetes is diagnosed from ages 15 to 30 years, type 2 patients are less likely than are type 1 patients to reach their 50th birthday, according to investigators from the University of Sydney.

Even just a few years after diagnosis, young type 2 patients have a worse cardiovascular profile and worse cardiovascular disease, which leads to an earlier death.

“We pay less attention to type 2 than type 1 in young people. They’re not as sick, and don’t develop [diabetic ketoacidosis] if they miss a treatment. But young type 2 is not a milder form of diabetes in young people, and its detrimental impact occurs early. Before we know what’s going on, patients are middle age, and it’s too late,” said investigator Maria Constantino, a Ph.D. candidate, nurse, and diabetes researcher and educator at the University of Sydney.

Screening for type 2 diabetes “should start at a young age in at-risk groups,” and diabetes cardiovascular risk criteria should be reconsidered so that younger type 2 patients aren’t overlooked because of their age. Current criteria likely “lead to delay in preventive treatment” in the young, she said.

The conclusions come from a review of diabetes patients treated since 1990 at the Royal Prince Alfred Hospital in Sydney (Diabetes Care. 2013 Dec; 36[12]:3863-9).

The investigators compared 354 type 2 patients with 470 type 1 patients diagnosed from age 15-30 years. By around the age of 40 years, 11% of the type 2 patients had died, vs. 6.8% with type 1 (hazard ratio, 2.0; 95% confidence interval, 1.2-3.2; P = .003). Strokes, coronary artery disease, and other macrovascular complications were also far more common in the type 2 group, and they had worse hypertension and dyslipidemia despite taking more drugs to combat both. Type 2 patients also had more albuminuria and neuropathy.

The differences occurred despite the fact that type 2 patients smoked less, had a slightly shorter duration of disease (11.6 vs. 14.7 years), and equivalent glycemic control with their type 1 counterparts, with a mean hemoglobin A_1c of 8.1% in both groups. They were heavier, however, with a mean body mass index of 32.2 kg/m² vs. 25.6 kg/m² in type 1 patients.

In short, young-onset type 2 is a “more lethal phenotype of diabetes. We are not saying one type of diabetes is more important; we need to conquer both.” But in young type 2 patients, “we need to focus on more than just glycemic control.” Cardiovascular risk factors are “detectable early, and treatable,” Ms. Constantino said.

The investigators also compared their 354 young-onset type 2 patients with 1,062 patients diagnosed from age 40-50 years.

By the time they were about 50 years old, young-onset patients were 6.5 times more likely to have died than were their age-matched peers without diabetes in the general Australian population. The peak in excess mortality for those diagnosed in their 5th decade came at about age of 65 years, with a risk of death about 2.5 times higher than nondiabetic peers in the general population.

“The impact of type 2 is much higher the younger a person is. You can argue that in our enthusiasm to diagnose diabetes, we are casting our screening net wider and wider, and take pride in diagnosing many elderly patients with diabetes, but we should not lose sight of the fact that finding and treating an elderly person with diabetes has much less impact than finding and treating one in a young age group,” she said.

Ms. Constantino has no conflicts of interest.

[email protected]

Vancouver, B.C. – If a patient is admitted to the hospital with a plasma glucose at or above 140 mg/dL, it’s wise to check the hemoglobin A_1c level to catch undiagnosed diabetes, according to British and Irish researchers.

“A combination of admission plasma glucose and hemoglobin A_1c can be used to diagnose diabetes in acute medicine, provided care is taken when interpreting hemoglobin A_1c results, as they can be affected by various medical conditions or certain drugs,” said investigator Dr. Sandip Ghosh, a diabetologist at Queen Elizabeth Hospital in Birmingham, England.

The conclusion comes from a review of 2,061 white inpatients at University Hospital Waterford (Ireland), 412 (20%) of whom were diagnosed with diabetes on admission or displayed symptoms and complications.

An admission plasma glucose level of 140.4 mg/dL correlated with a hemoglobin A_1c of 6.5%, the threshold for diabetes diagnosis. If ordering a hemoglobin A_{1c is delayed until the plasma glucose reaches 200 mg/dL}, “we are missing an awful lot of people with diabetes,” Dr. Ghosh said.

The linear correlation between admission plasma glucose and hemoglobin A_1c levels wasn’t perfect (r² = 0.63, P less than 0.001). The approach was highly specific but not very sensitive, possibly because of a hemoglobin A_1c level that has been compromised by liver, renal, or other problems, said investigator Susan Manley, Ph.D., a biochemist at the Birmingham hospital.

The Joint British Diabetes Society is planning to release a nationwide guideline for diabetes screening at hospital admission, but the quickest and most cost-effective way to screen for diabetes is uncertain.

Dr. Ghosh and Dr. Manley are both involved with those efforts, and their study is an attempt to solve the problem. They and their colleagues are planning a prospective study of hemoglobin A_1c screening approaches in a more racially diverse population.

Eventually, “we are going to use” these findings to help write the recommendations, but “we need to make sure emergency wards do make the measurements,” and that labs can handle an upsurge in hemoglobin A_1c testing, Dr. Manley said.

For now, hemoglobin A_1c is generally used to check glucose control in hospital patients already known to have diabetes, both in the United Kingdom and the United States. It’s attractive as a hospital screening tool, however, because it can help discriminate between patients who truly have diabetes and those who are hyperglycemic because of acute illness.

The study analyzed admission plasma glucose, hemoglobin A_1c, oral glucose tolerance tests, and other measures in consecutive, short-term medical admissions to the Waterford hospital from 2005 to 2007. The researchers calculated that hemoglobin A_1c screening would have identified about 40 more cases of diabetes.

The authors reported no conflicts of interest.

[email protected]

Vancouver, B.C. – If a patient is admitted to the hospital with a plasma glucose at or above 140 mg/dL, it’s wise to check the hemoglobin A_1c level to catch undiagnosed diabetes, according to British and Irish researchers.

“A combination of admission plasma glucose and hemoglobin A_1c can be used to diagnose diabetes in acute medicine, provided care is taken when interpreting hemoglobin A_1c results, as they can be affected by various medical conditions or certain drugs,” said investigator Dr. Sandip Ghosh, a diabetologist at Queen Elizabeth Hospital in Birmingham, England.

The conclusion comes from a review of 2,061 white inpatients at University Hospital Waterford (Ireland), 412 (20%) of whom were diagnosed with diabetes on admission or displayed symptoms and complications.

An admission plasma glucose level of 140.4 mg/dL correlated with a hemoglobin A_1c of 6.5%, the threshold for diabetes diagnosis. If ordering a hemoglobin A_{1c is delayed until the plasma glucose reaches 200 mg/dL}, “we are missing an awful lot of people with diabetes,” Dr. Ghosh said.

The linear correlation between admission plasma glucose and hemoglobin A_1c levels wasn’t perfect (r² = 0.63, P less than 0.001). The approach was highly specific but not very sensitive, possibly because of a hemoglobin A_1c level that has been compromised by liver, renal, or other problems, said investigator Susan Manley, Ph.D., a biochemist at the Birmingham hospital.

The Joint British Diabetes Society is planning to release a nationwide guideline for diabetes screening at hospital admission, but the quickest and most cost-effective way to screen for diabetes is uncertain.

Dr. Ghosh and Dr. Manley are both involved with those efforts, and their study is an attempt to solve the problem. They and their colleagues are planning a prospective study of hemoglobin A_1c screening approaches in a more racially diverse population.

Eventually, “we are going to use” these findings to help write the recommendations, but “we need to make sure emergency wards do make the measurements,” and that labs can handle an upsurge in hemoglobin A_1c testing, Dr. Manley said.

For now, hemoglobin A_1c is generally used to check glucose control in hospital patients already known to have diabetes, both in the United Kingdom and the United States. It’s attractive as a hospital screening tool, however, because it can help discriminate between patients who truly have diabetes and those who are hyperglycemic because of acute illness.

The study analyzed admission plasma glucose, hemoglobin A_1c, oral glucose tolerance tests, and other measures in consecutive, short-term medical admissions to the Waterford hospital from 2005 to 2007. The researchers calculated that hemoglobin A_1c screening would have identified about 40 more cases of diabetes.

The authors reported no conflicts of interest.

[email protected]

Vancouver, B.C. – If a patient is admitted to the hospital with a plasma glucose at or above 140 mg/dL, it’s wise to check the hemoglobin A_1c level to catch undiagnosed diabetes, according to British and Irish researchers.

“A combination of admission plasma glucose and hemoglobin A_1c can be used to diagnose diabetes in acute medicine, provided care is taken when interpreting hemoglobin A_1c results, as they can be affected by various medical conditions or certain drugs,” said investigator Dr. Sandip Ghosh, a diabetologist at Queen Elizabeth Hospital in Birmingham, England.

The conclusion comes from a review of 2,061 white inpatients at University Hospital Waterford (Ireland), 412 (20%) of whom were diagnosed with diabetes on admission or displayed symptoms and complications.

An admission plasma glucose level of 140.4 mg/dL correlated with a hemoglobin A_1c of 6.5%, the threshold for diabetes diagnosis. If ordering a hemoglobin A_{1c is delayed until the plasma glucose reaches 200 mg/dL}, “we are missing an awful lot of people with diabetes,” Dr. Ghosh said.

The linear correlation between admission plasma glucose and hemoglobin A_1c levels wasn’t perfect (r² = 0.63, P less than 0.001). The approach was highly specific but not very sensitive, possibly because of a hemoglobin A_1c level that has been compromised by liver, renal, or other problems, said investigator Susan Manley, Ph.D., a biochemist at the Birmingham hospital.

The Joint British Diabetes Society is planning to release a nationwide guideline for diabetes screening at hospital admission, but the quickest and most cost-effective way to screen for diabetes is uncertain.

Dr. Ghosh and Dr. Manley are both involved with those efforts, and their study is an attempt to solve the problem. They and their colleagues are planning a prospective study of hemoglobin A_1c screening approaches in a more racially diverse population.

Eventually, “we are going to use” these findings to help write the recommendations, but “we need to make sure emergency wards do make the measurements,” and that labs can handle an upsurge in hemoglobin A_1c testing, Dr. Manley said.

For now, hemoglobin A_1c is generally used to check glucose control in hospital patients already known to have diabetes, both in the United Kingdom and the United States. It’s attractive as a hospital screening tool, however, because it can help discriminate between patients who truly have diabetes and those who are hyperglycemic because of acute illness.

The study analyzed admission plasma glucose, hemoglobin A_1c, oral glucose tolerance tests, and other measures in consecutive, short-term medical admissions to the Waterford hospital from 2005 to 2007. The researchers calculated that hemoglobin A_1c screening would have identified about 40 more cases of diabetes.

The authors reported no conflicts of interest.

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