Day Two of the European Association for the Study of Diabetes annual conference
Why is this important?
Because we know that diabetes and, indeed, many other conditions, are not one-size-fits-all conditions. Sometimes a drug will work in one person but not have the same effect in another. And another subset may have side effects that some do not witness. And this can be expensive.
It takes between 11 and 14 years for a drug to come to market and the attrition rate is high – only 1 in every 10,000 compounds tested by the pharmaceutical and biotech industry eventually obtains approval for the US Food and Drug Administration, and the conditional probability of getting a compound from the so-called Investigational New Drug Application through to market is less than 1%.
So, if the costs of making a drug are high and the possibly of a drug not working in everyone is also significant, is there a way to stratify the population with diabetes into various different clusters?
People who respond to a drug and do not have side effect through to non-responders who do have side effects would be an easy and simple stratification.
However, there is much more sophisticated work underway looking at specific genetic patterns seen in certain populations and linking these key genetic loci with key biochemical traits, such as fasting insulin and lipid levels, waist circumference and hip circumferences, and body mass index.
It is a fascinating look into the future – and involves new genetic mutations recently discovered in the Inuit population of Greenland, a largely under-investigated group, who may yet lead to advances in the precision medicine.
From there, I move, via a little dip into diabetes-related retinopathy and then into beta cell failure, to two more issues that are absolutely at the forefront of the management and treatment of diabetes – bariatric surgery and yet more on the drug class of the moment, SGLT-2 inhibitors.
Bariatric surgery – weight loss and additional side effects
Feeding the pipeline: From drugs to surgery was a well-attended session and the range of topics covered impressive. Bariatric surgery is associated with improvements in glycaemic control, blood pressure, lipid levels and, of course, obesity. Can it also affect the microvascular complications of diabetes like diabetes-related foot disease, diabetic retinopathy and chronic kidney disease?
Using an impressive UK database, which records data from primary care, one group presented results indicating that, in a defined cohort of people who had received bariatric surgery, there was a 47% drop in the development of microvascular complications compared to the non-surgical cohort.
The greatest reduction was noted in the people who had received a gastric bypass compared to those who had received a gastric band or a sleeve gastrectomy. And the impact of this outcome became apparent between one and two-years post-surgery.
Looking at the individual components in the study, the incidence of diabetes-related foot disease was decreased by around 40%, sight-threatening diabetes-related retinopathy by 35% and diabetes-related kidney disease by 37%.
This is an observational study but these initial results would indicate that improving access to bariatric surgery could reduce the burden of type 2 diabetes by reducing the incident of microvascular complications associated with the condition and which are costly to healthcare systems around the world.
A new SGLT-1 inhibiter on the block
I end the second day of this virtual conference at the VERTIS CV Outcome session.
VERTIS CV was a study investigating the effects of another of the SGLT-1 inhibiter gliflozin class, namely ertugliflozin. Given the impressive recent study results with empagliflozin, dapagliflozin and canagliflozin in type 2 diabetes, these are already big boots to fill. So how did this new kid on the block fare?
The drug was found to be safe, well-tolerated and with a side-effect profile similar to those seen with the other drugs in the class. The results provided further evidence supporting the beneficial effects of this drug class on cardiovascular and kidney outcomes. Ertugliflozin caused a 40% decline in kidney replacement therapy and renal death and preserved kidney function especially in those at the greatest risk of diabetes-related kidney disease progressions.
This led the team responsible for announcing these results to conclude continued support for the contemporary society recommendations from round the world that currently prioritise the use of SGLT-2 inhibitors in people with type 2 diabetes either with or at high risk for cardiovascular and kidney complications.
Food for thought
So, another busy day closes and I am impressed by the number of people logging into the sessions, asking questions remotely and being as engaged in these engaging sessions as I am. I’m just missing the sachertorte!
Read Dr Eleanor Kennedy’s blog report from Day One of the EASD annual meeting here
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