DRWF Research Manager Dr Eleanor Kennedy reports from the fourth day of the 13th International Conference on Advanced Technologies and Treatments for Diabetes in Madrid, Spain.
The last day of this wonderful little conference is upon me almost before I know it. Mind you, to say it is small is perhaps to do it a disservice given that there are more than 3,800 delegates here.
Normally as conferences wind to a close, the numbers of people attending the sessions dwindle considerably, but I am amazed to find all three sessions this morning filled.
Indeed, for the very last session, two overflow rooms need to be hastily commandeered!
The last day is only a half-day in fact so I pack in what I can starting in the early morning at a NAFLD/NASH session.
NAFLD is the thankfully much shorter way of saying non-alcoholic fatty liver disease and NASH stands for non-alcoholic steatohepatitis.
Why are they important?
Because there is an increasing prevalence of both NAFLD and NASH, the progressive form of NAFLD, in people with type 2 diabetes and people with NASH have an increased risk of cardiovascular disease and death.
The prevalence of NAFLD and NASH is around 24% in Europe, but this rises to 68% in those with type 2 diabetes. In the Middle East it rises from around 32% in those without the condition to more than 67% making this a real global health concern.
To compound this problem, there are currently no drugs approved for the treatment of NASH and only diet and exercise are the mainstays of treatment.
As a result, healthcare systems around the world are becoming even more stretched as cases of NASH loom large, leading to adverse clinical outcomes – both liver- and non-liver-related – and tremendous economic burden and poor patient-related outcomes.
For this conference, all of the lecture halls and auditoriums are named after European cities. So I can easily wander from Paris to London, or from Luxembourg to Berlin. In the case of my next move, I travel from Rome to Madrid to hear the last two sessions of the congress.
Diabetes complications and effects on the brain
The first is on hypoglycaemia (low blood sugar levels) and the brain. Two very well-known physicians hailing from the UK walk the audience through some elegant studies on the consequences of hypoglycaemia.
Part of the brain, the thalamus, is highlighted as being a player in those with impaired hypoglycaemic awareness and altered responses in regions of the brain involved in executive function, motivation and memory may account for the different behavioural responses to hypoglycaemia in those with impaired hypoglycaemia awareness. And it may be these adaptations that create barriers to effective behavioural changes that may, in turn, reduce the risk of future hypoglycaemia.
The second is entitled A glimpse to the future and it features two speakers – one on the long-term outcomes from metabolic surgery and one speaking about towards a cure for type 1 diabetes.
Metabolic or bariatric surgery is debated as being as safe as an uncomplicated childbirth and how earlier referral leads to better outcomes.
The engaging speaker suggests that the biggest contribution of this kind of surgery may actually be in the opening up of new areas of research and the development of better medications for type 2 diabetes.
This New England Journal of Medicine article on unlicensed stem cell clinics was discussed on the final day of the ATTD conference
The future of treatment for people living with type 1 diabetes
We finish more or less where we started on Day One with Professor Jay Skyler.
On the first day of the conference Professor Skyler gave us a wonderful retrospective of how far we’ve come since the discovery of insulin.
On the fourth and final day, he turns his vision on the future rather than the past and gives a packed house his view of beta cell replacement therapies as the way forward with regards to a cure for type 1 diabetes.
As I covered recently in my blog posts from the EPITA conference in Austria, there is much research in this arena from embryonic stem cells to induced pluripotent stem cells to adult stem cells, each with their own raft of pros and cons.
Professor Skyler ends with a recent publication entitled Medicine’s Wild West – Unlicensed Stem Cell Clinics in the United States. Recognising everyone’s desire for good health, many unscrupulous providers are promising miracle cures with stem cell treatments for a whole range of conditions including type 1 diabetes. But these cannot be allowed to profit from untested products that could prove more harmful than beneficial.
His message is one of hope. Not hype.
And I hope that, by the time the next ATTD conference rolls around in 2021, thanks to robust, global efforts in the research sector, there will be much more hope on the horizon for those living with diabetes.