Type 2 diabetes research highlights from the EASD – by Emily Burns



I’ve already given a quick overview of some of the big announcements made at the European Association for the Study of Diabetes (EASD) meeting around Type 1 diabetes. But of course it wasn’t all Type 1, Type 2 was very much on the agenda – here’s the latest.

We’ve got to mix it up

Professor Cooper, from Australia, opened the conference with the Claude Bernard lecture, highlighting the importance of using multiple drugs to combat the complications of diabetes.

He used the example of the NOX proteins, a family of enzymes that carry out multiple functions in our cells. They found that stopping the activity of one of the enzymes (called NOX1) could block the development of atherosclerosis, while stopping the activity of another family member – NOX4 – could block the development of nephropathy (diabetes-related kidney damage).

In theory, that would require two different drugs, but fortunately drugs that can target both enzymes are already in clinical trials.

A new marker for Type 2 diabetes complications

Dr Mathilde Fraty presented interesting data, identifying a new biomarker (a protein used to indicate or predict the development of a condition) for cardiovascular complications in Type 2 diabetes.

They followed 1300 people with Type 2 diabetes for an average of six years, and found that the levels of a protein called Angiopoietin like-2 (or Angptl2) were higher in those that had died during the follow up, compared to those that hadn’t.

This might mean that measuring Angptl2 could be used to identify patients at a higher risk cardiovascular complications, providing an opportunity to step in and alter treatment. It’s early days, and more research is needed before the team would suggest changing clinical practice.

Fat and muscle

Professor Peter Schrauwen from the Netherlands presented the prestigious Minkowski Lecture, taking us through the latest research into the links between fat, muscle and Type 2 diabetes.

clock_300x222The link between sleep and Type 2 diabetes is commonly talked about, and Professor Shrauwen presented work published this year around circadian rhythm. Our bodies have clocks that respond to light, diet and exercise – this clock also regulates our metabolism, and is therefore likely to have an impact on insulin sensitivity as well.

Early human studies suggest that our circadian rhythm is connected to how muscle cells metabolise energy. While it’s too early to be sure, perhaps disrupting the rhythm could influence our risk of Type 2 diabetes.

He also mentioned the cold. We’re not talking freezing temperatures – more 14-15 degrees Celsius. People have different types of fat tissue, and it’s thought that the brown tissue could have some protective effects against obesity and Type 2 diabetes. (We’re funding research in this area at the moment).

So researchers are looking at whether being exposed to this lower temperature can turn white fat tissue into the good brown stuff. Early research in people with Type 2 diabetes suggests it might help: they saw a slight increase in the levels of brown fat tissue, and significant improvements in insulin sensitivity.

SUSTAIN-6 trial results

The US Food and Drug Administration (FDA) and European Medicines Agency (EMA) now require proof that Type 2 diabetes glucose-lowering drugs don’t cause cardiovascular harm. This means that there have been several big cardiovascular safety studies underway, with the results of the EMPA-REG and LEADER trials being announced already.

Heart medicine

This time, it was Novo Nordisk’s turn to announce the results of the SUSTAIN-6 trial. SUSTAIN-6 involved 3200 people with Type 2 diabetes, and was spread out across 230 sites in 20 countries (so pretty big), testing the cardiovascular safety of a GLP-1 agonist called semaglutide.

And the results followed the pattern of the previous studies; semaglutide reduced the risk of both non-fatal heart attacks and non-fatal stroke. Interestingly, it didn’t have an impact on the overall risk of death from cardiovascular complications.

The results have been published, and it’s promising to see that another Type 2 diabetes drug has been shown to have some cardiovascular benefits. It’s difficult to know which ones pose the most benefit: hopefully a comparison trial will give us the answers in the future.

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This blog is brought to you by Dr Emily Burns, Research Communications Manager at Diabetes UK.

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