Landmark Trials in Heart Failure—DELIVER and EMPEROR-Preserved—Will SGLT2 Inhibitors Succeed in Heart Failure with Preserved Ejection Fraction?
Vaduganathan M presented on whether SGLT2 Inhibitors Succeed in Heart Failure with Preserved Ejection Fraction (HFpEF), on Saturday June 26, 2021 at American Diabetes Association (ADA) 81st Scientific Sessions, a Virtual Experience. The current therapies for Heart Failure with reduced Ejection Fraction (HFrEF) include quadruple therapy which promises reduced mortality & improved quality of life. While management of HFpEF has fewer supporting evidences, with guidelines recommending BP control (Class I) with beta-blocker and/or ACEi/ARB (Class II), MRA (Class IIb) and ARNI (select cases). Recently FDA expanded indication of Sacubitril/Valsartan in chronic HF with low LVEF resulting in reduced risk of CV death and hospitalizations.
SGLT2i have demonstrated attenuation of adverse LV remodelling & reduced LV mass in HFpEF patients. SGLT2i lowered intra-cardiac filling pressures & have clinically significant antihypertensive effects. In CREDENCE, canagliflozin reduced BP by 3-4 mmHg & reduced need of additional BP drug. The EMPEROR-Preserved trial intended to investigate safety & efficacy of empagliflozin 10 mg in patients with HFrEF or HFpEF with or without T2D, the results of which are awaited. DELIVER, is another clinical trial including 6263 patients with HFpEF randomized to receive dapagliflozin 10 mg and placebo. It will conduct a dual primary analyses of full trial population & those with LVEF <60%. These trials set to fill the key evidence gaps in the treatment of patients with HFpEF.
SGLT2i are promising agents targeting HFpEF pathogenesis and symptomatology and are expected to demonstrate clinically relevant lower hospitalization burdens and improvement in QOL.
Landmark Trials in Kidney Disease—DAPA-CKD—Extending the Benefits of SGLT2 Inhibition to and beyond Diabetic Kidney Disease
Wheeler DC presented the outcomes of dapagliflozin and prevention of adverse events in chronic kidney disease patients (DAPA-CKD) trial on Saturday June 26, 2021 at American Diabetes Association (ADA) 81st Scientific Sessions, a Virtual Experience. The study included 4304 patients ≥ 18 years, eGFR 25-75 ml/min/1.73m2, UACR 200-5000 mg/g and on stable maximum tolerated labelled dose of ACEi or ARB for ≥ 4weeks. They were randomized to receive dapagliflozin 10 mg or placebo and evaluated at regular intervals for 4 months. After an initial drop in eGFR, dapagliflozin led to levelling out of the eGFR value with slower decline compared to placebo. A significant reduction in all-cause mortality was observed with dapagliflozin primarily driven by fall in non-CV deaths. The study also highlighted that although most patients had diabetic neuropathy as the primary cause of kidney disease, not all patients with CKD may have it due to T2D. Dapagliflozin had fewer adverse events than placebo and no incidences of diabetic ketoacidosis. It demonstrated better outcomes in patients with IgA nephropathy and focal segmental glomerulosclerosis. Dapagliflozin had similar effects all the etiologies of the entire study population w.r.t. kidney-specific outcomes, CV death or all-cause mortality.
In DAPA-CKD, dapagliflozin reduced the risk of kidney failure, risk of death form CV causes and prolonged survival in patients with CKD and with or without T2D. These effects were consistent irrespective of patients’ etiologies.
COVID-19 and Type 1 Diabetes—Maintaining Control and Addressing Concerns
DeMeglio LA, presented a session at the American Diabetes Association (ADA) 2021 81st scientific sessions: virtual congress. The basic and clinical interrelationships between COVID-19 and diabetes have exploded in recent years. Rapid reports were initially useful for providing alerts and guiding health-care responses and policies. Some of these have since proven to have significant benefits, while others lacked scientific rigour and reproducibility. Many publications that discuss COVID-19 and “diabetes” do not differentiate between type 1 and type 2.
Persons with T1D are not more susceptible to SARS-CoV-2 infection than other individuals: should follow all general population public health advice, particularly important as more-transmissible and possibly less vaccine-susceptible SARS COV-2 variants circulating. As compared to peers, Persons with T1D and COVID who are adults are at increased disease-related risk.
Factors associated with greater risk in T1D: over age 55 years, black race, longer-standing diabetes, higher hemoglobin A1c (particularly >10%), vascular complications, greater BMI, less use of diabetes technology and use public insurance. Due to short duration of disease and lack of vascular complications, children with T1D are unlikely to develop severe COVID. Persons with T1D have experienced limited access to regular health care, particular during lockdowns. This has been associated with: (1) more DKA both in persons with new onset and established T1D, (2) difficulties sharing glucose data as well as insulin dose data and (3) fears of reduced telemedicine care efficacy compared to person visits. It was reported that those with better glycemic control had less alcohol consumption, did more frequent flash glucose monitor scans and perceived diabetes control to be easier.
Persons with T1D and COVID who are adults are at increased disease-related risk compared to peers. There is still need for prospectively collected, longitudinal, retrievable public data on incidence trends and disease outcomes.
Diabetes and COVID-19 at 18 Months—Trouble Ahead, Trouble Behind
Gregg EW presented a study “Diabetes and COVID-19 at 18 Months—Trouble Ahead, Trouble Behind” at American Diabetes Association (ADA) 81st Virtual Scientific Session. 18 months into SARS-CoV-2 (COVID-19) pandemic, epidemiologic studies indicate-
- Diabetes mellitus is a central contribution to severe COVID-19 morbidity and conversely, COVID-19 has had a devastating effect on the population with diabetes.
- It accounts for 30-40% of hospitalizations, severe morbidity and deaths.
- Among hospitalized cases with diabetes, about 21-43% required intensive care with a case fatality of 25%.
- Overall mortality rates were 50% higher than historical trends, twice that of the general population.
- The pandemic was associated with about 20% of excess or collateral deaths.
- Key predictors of poor outcomes include comorbid conditions (chronic kidney disease, coronary heart disease, heart failure, concurrent obesity, acute and chronic poor HbA1c control).
- We need to see if exposure, infection and hospitalization risk differed according to diabetes status, impact before, outside of and beyond hospitalization and local protection policies (shielding and lockdown)
- Factors in care, management and behaviours that were most dramatically affected during the pandemic must be looked at, unintended benefits of the pandemic have resulted in rapid innovation in care
- The effectiveness of the full range of potential interventions to mitigate risk, use of local and variation over time along with the vaccination program’s effect on populations with diabetes must be assessed.
Thus, it is essential to understand the full cascade of risk, full range of indirect effects of the pandemic and exploit the wealth of natural experiments.
Hypoglycemia Increases the Left Ventricular Ejection Fraction in People with Diabetes and Healthy Controls
A clinical trial by Fabricius TW was presented on Saturday June 26, 2021 at American Diabetes Association (ADA) 81st Scientific Sessions, a Virtual Experience. The objective of this study was to evaluate the effect of hypoglycemia on left ventricular ejection fraction (LVEF) and global longitudinal strain in people with Type 1 Diabetes.
The study comprised of 15 adults with Type 1 diabetes mellitus and 14 healthy controls. All the participants underwent a hyperinsulinemic normoglycemic and hypoglycemic glucose clamp. A cardiac ultrasound was carried out at baseline and 30 minutes into the hypoglycemic phase.
Based on the analysis of the results, it was found out that no one developed arrythmia during hypoglycemia. Additionally, no difference was found for LVEF between type 1 diabetes mellitus patients and healthy controls. It was observed that the LVEF increased from 58.1±2.6% at baseline to 63.7±4.0% in the Type 1 diabetes mellitus group (p<0.0005) and from 58.0±3.8% to 64.7±2.4%, (p<0.005) in the healthy control group. The GLS remained unchanged in the Type 1 diabetes mellitus patients while there was a decrease that was observed in the healthy controls.
Due to the catecholamines chronotropic, inotropic and peripheral contracting effect, hypoglycemia appears to increase the LVEF in people with diabetes. This further leads to increased cardiac output, oxygen consumption, and metabolism and in turn an increased load on the heart. Thus the link between hypoglycemia and cardiac diseases appears to be justified.
Structural Grey Matter Alterations and Cognitive Function in Diabetes: A UK Biobank Study
A study by Burgess J was presented on Saturday June 26, 2021 at American Diabetes Association (ADA) 81st Scientific Sessions, a Virtual Experience. The purpose of the study was to characterize the areas of global and anatomical grey matter volumes using T1- weighted magnetic resonance brain imaging.
The study comprised of participants with diabetes (n = 569) and people without diabetes (n = 20801). The diabetes group included more men and the BMI and the systolic blood pressure were found to be higher in diabetes patients than those without diabetes. No change in the diastolic blood pressure was observed.
Based on the analysis of the results, it was found out that the volume of the peripheral cortical grey matter, superior frontal gyrus, left middle frontal gyrus, right anterior division of the supramarginal gyrus, right posterior supramarginal gyrus, paracingulate gyrus, precentral gyrus and left post central gyrus were all lower in diabetes patients as compared to those who do not have diabetes.
Thus, it can be implied that people with diabetes have a noticeable reduction in grey matter volume in distinct brain regions as previously hinted at in the literature.
Fibro-inflammatory Plasma Biomarkers and Relation to Cardiovascular Remodelling in Type 2 Diabetes (T2D)
A study by Brady EM was presented on Saturday June 26, 2021 at American Diabetes Association (ADA) 81st Scientific Sessions, a Virtual Experience. The objective of this secondary analysis was to assess the relationship between multiple fibro – inflammatory biomarkers and cardiovascular structure and functions in patients with type 2 diabetes mellitus and also to evaluate the impact of lifestyle interventions such as exercise training and meal replacement plan.
The data for the analysis was obtained from a randomized controlled trial. Type 2 diabetes mellitus patients with no cardiovascular disease were randomized to a 12-week intervention of supervised aerobic exercise training, low energy meal replacement plan or standard care. The fasting bloods for fibro-inflammatory biomarkers and cardiac MRI (CMR) were undertaken pre- and post-intervention. Subsequently, principal component analysis was undertaken to assess and understand the relationship between CMR outcomes of interest, key demographic variables and the fibro inflammatory biomarkers.
Based on the result, it was found out that people with type 2 diabetes mellitus had an adverse fibro – inflammatory profile as compared to the controls. The PCA 3D-visulisation containing demographics, biomarkers and CMR data showed complete separation between controls and those with type 2 diabetes mellitus. Additionally, following the intervention of the meal replacement plan, there was a significant shift in the PCA but no change was observed for the exercise intervention.
Thus, the variations in fibro – inflammatory pathways impact the CV structure and function before the onset of symptomatic heart failure in people with Type 2 diabetes.
The fibro inflammatory profile appeared to improve with the intervention of the meal replacement plan but not with exercise. In order to establish a fool proof connection between reduction of symptomatic heart failure and institution of a meal replacement plan, long term studies are required.
Predictive Role of Atherosclerosis Biomarkers on Carotid Plaque Extension in Type 2 Diabetes
A study by Leonetti S was presented on Saturday June 26, 2021 at American Diabetes Association (ADA) 81st Scientific Sessions, a Virtual Experience. The objective of this study was to evaluate the predictive role of matrix metalloproteinases (MMP) and tumor necrosis factor receptor superfamily members in type 2 diabetes.
The study comprised of a cohort of 1144 patients suffering from carotid atherosclerosis. Plasma levels of MMP-12, MMP-7, CD40 and its ligand (CD40-L) were measured by Proximity extension assay and the carotid plaque area was measured by plaque contours.
Based on the results, it was found out that CD40 demonstrated the strongest effect and MMP12 displayed a notable interaction with type 2 diabetes. Additionally, the effect of MMP-12 and MMP-7 remained remarkable only in type 2 diabetes, while the effect of CD40 and CD40-L was found to be similar in both subgroups.
Thus, this study highlights the ability of MMP-12, MMP-7, CD40, and CD40-L in predicting carotid atherosclerotic burden in a population of high cardiovascular risk. Subsequently, it recognizes MMP-12 as a specific biomarker for type 2 diabetes.
Patient Engagement in Diabetes Self-Management Education and Support (DSME/S) Using Immersive Virtual World Technology
A study by Mitchell S was presented on Saturday June 26, 2021 at American Diabetes Association (ADA) 81st Scientific Sessions, a Virtual Experience. Online technologies such as virtual world platforms increase patient engagement in diabetes self-management education and support.
The objective of this study was to evaluate the sense of presence rendered by a virtual world platform and the role it played in fostering patient engagement. The presence in a virtual world setting was defined as a feeling of being immersed in an environment despite its artificiality.
The study comprised of 145 participants who were randomized to the virtual world study arm and a triangular mixed method design embedded within the women in control 2.0 trial was used. The participant experience of physical, self and social presence in the virtual world was evaluated and around 63 participants participated in the qualitative interviews. Participant experiences in the virtual world were assessed with qualitative data and multimodal presence scale scores were calculated.
Subsequent to collecting the qualitative and quantitative data independently, a conceptual mapping process was to put to use in order to integrate them. Based on the analysis, it was found that, half the participants were over 56 years of age and had a mean baseline HbA1c value of 9.9%. Around two-thirds of the virtual world participants reported a sense of social (63.7%) and physical (63.1%) presence, while the other half experienced self (49.0%) presence in the virtual world.
The data integration led to three major themes with respect to “presence” in a virtual world. (1) Self-presence promotes user recognition with the personalized avatar (2) Physical presence encourages a growth mindset through imaginative play and visualization, and (3) social presence promotes peer social support.
Thus, patient engagement in diabetes self-management education and support is intensified by the sense of physical, social and self- presence encountered by learners when using immersive technology software in a peer group context.
Pathways of Health Literacy, Empowerment, Self-Care Activities to Quality of Life and Glycemic Control in Patients with Type 2 Diabetes
Zhao X, presented a session at the American Diabetes Association (ADA) 2021, 81st scientific sessions: virtual congress. This study was conducted to estimate the pathways of health literacy, empowerment, self-care activities to quality of life and hemoglobin A1c (HbA1c) in type 2 diabetes patients.
In this cross‐sectional study, from four hospitals in China, 310 type 2 diabetes patients were enrolled through convenience sampling. To establish the database, EpiData 3.1 was used. Except for the structural equation modelling analysis, which was performed with Amos 26.0, all data data were analyzed with SPSS 25.0. The significance threshold was set at p<0.05.
The findings were reported as follows:
- Significant direct pathways were identified:
- From health literacy to empowerment (β=0.647, p<0.001), and self-care activities (β=0.487, p<0.001).
- From empowerment to quality of life (β=-0.288, p<0.001), and self-care activities (β=0.613, p<0.001).
- From self-care activities to HbA1c (β=-0.134, p=0.028).
- Indirect pathways were identified:
- From health literacy to quality of life (β=-0.186, p=0.004) via empowerment.
- From health literacy (β=-0.118, p=0.046) or empowerment (β=-0.082, p=0.045) to HbA1c via self-care activities.
This study reported that empowerment is crucial to the link between health literacy and quality of life. In patients with type 2 diabetes, health literacy and empowerment are essential factors in improving glycemic control through self-care activities.
The Future of Insulin as a Therapy
Michael A, Weiss presented a study “The Future of Insulin as a Therapy” at the American Diabetes Association (ADA) 81st Virtual Scientific Session.
We are just beginning to understand the process(es) by which preproinsulin enters the ER, and the pathophysiological consequences of defects in preproinsulin translocation. MIDY mutations trigger proinsulin disulfide-linked complex formation that inhibits efficient insulin production. Misfolded proinsulin may be cleared in part by EARD and in part by ER-macroautophagy (ER-phagy). Disulfide mispairing and accumulation of proinsulin disulfide-linked complexes misfolding with or without INS gene mutations, predisposition to proinsulin misfolding is a risk factor that enhances susceptibility to diabetes.
Some classes of glucose-responsive systems include- mechanical (CGM-coupled insulin pumps and closed-loop systems), polymer-based (glucose-responsive lectins and matrices), bio-inspired carriers (albumin and GLUT channels), Metabolic clearance (mannose receptor) and uni-molecular GRIs.
The goal remains to create “smart insulins” to mitigate the risk of hypoglycemia. The following are the considerations that need to be addressed-
- To avoid the acute effects of “lows”, the molecule must be safe.
- It should be efficient to enable tight glycaemic goals (time in range)
- Prevent microvascular complications DCCT/EDIC
- Prevent cognitive decline-chronic hypoglycaemic episodes
- Development of compatible technologies
- Reduce the burden of care and self-care thereby improving the quality of life.
Future therapeutic modules need to incorporate knowledge from several and develop a strategy that is a combination of these technologies. The next-generation therapy should be designed to be safer, efficient, compatible and improve quality of life outcomes.
Metformin Improves Cardiac and Aortic Parameters in Adolescents with Type 1 Diabetes
Alexander Nguyen presented a study “Metformin Improves Cardiac and Aortic Parameters in Adolescents with Type 1 Diabetes” at American Diabetes Association (ADA) 81st Virtual Scientific Session.
Despite the advances in glucose control people with type 1 diabetes (T1D) have higher rates of cardiovascular disease (CVD). Insulin resistance (IR) is known to be associated with CVD in type 2 diabetes not much is known about IR in T1D-related CVD. Adults with T1D were prone to conditions like vascular and cardiac dysfunction, including left ventricular (LV) dyssynchrony.
The EMERALD (Effects of MEtformin on caRdiovascular function in AdoLescents with type 1 Diabetes) study showed that metformin improved BMI, body composition, insulin sensitivity, arterial stiffness and carotid intimal media thickness in T1D adolescents.
In a population of 43 T1D youth of mean age 16.8 ± 2.5 years, HbA1c 8.6 ± 1.5%, BMI 25.1 ± 4.3 kg/m2, with diabetic history of 7.7 ± 4.2 years were selected from the EMERALD study. These subjects were randomized 1000 mg BID of metformin (n=23) or placebo (n=20) for 3 months. The results were analyzed using echocardiograms with speckle tracking to evaluate traditional echocardiographic measures, cardiac strain and synchrony and aortic root diameter.
Based on one-way ANOVA and paired t-tests to assess the impacts of metformin, LV diameter 4.45 ± 0.47 at base line vs. 4.26 ± 0.50 cm after 3 months (p = 0.019) at end-diastole and at 2.89 ± 0.39 vs. 2.69 ± 0.36 cm (p = 0.022) at end-systole and LV dyssynchrony- 98.0 ± 36.9 vs. 81.7 ± 27.5 milliseconds (p = 0.014) showed significant improvement within the metformin group. Aortic root diameter in metformin group was 2.51 ± 0.39 compared to 2.73 ± 0.28 cm (p = 0.042) in placebo.
Aortic root diameter, LV diameter and LV dyssynchrony showed significant improvement post metformin treatment. Metformin can improve or reverse early cardiovascular changes in T1D detectable by echocardiogram. T1D-related CVD and the benefits of improving insulin action in T1D longer-term should be investigated further.
Efficacy and Safety of Evogliptin plus Metformin Added to Insulin Therapy in Elderly Indian Patients with Type 2 Diabetes
The combination of evogliptin plus metformin and insulin is well known for efficacy in the therapy of type 2 diabetes (T2D). However, longitudinal effectiveness and safety for elderly patients have not been demonstrated. Here, Guha S, presented a session at the American Diabetes Association (ADA) 2021 81st scientific sessions: virtual which analysed whether Evogliptin plus metformin added to insulin treatment showed improvement glycemic control for T2D patients older than 65 years of age.
32 T2D patients (male/female 20/12; age 76.2± 6.3 years, HbA1c 8.4±0.8%, DOD 6.9±2.1 years) who were given insulin were enrolled in the study and Evogliptin (5 mg) plus Metformin (500 mg) was added to their therapy procedure. Before and 6 months following adding Lira, metabolic variables and the data from CGM were evaluated.
Evogliptin plus metformin combination showed substantial improvement in HbA1c (from 8.4±0.8% to 7.2±1.2%; p=0.003) and body weight (from 62.8±8.3 kg to 61.2±4.6 kg, p=0.006) after 6 months despite the daily dose (from 58.5±11.2 IU/day to 45.63±14.4 IU/day, P=0.005) and number of insulin injections per day being decreased. CGM examination showed that SD and ≥180 mg/dL AUC were substantially reduced and hypoglycemic events were not increased. Additionally, 22% of patients with suboptimal glycemic control (A1C>7%) gained a composite outcome comprising of enhancement in A1C, weight loss and insulin dose decrease.
These findings recommend that the administration of Evogliptin plus Metformin could safely enhance glycemic control and decrease body weight in elderly patients with T2DM receiving insulin treatment. The reduction of glucose variation and number of insulin injections may enhance the quality of life of elderly T2D patients, particularly those who need social support.
Trends in Metformin Prescribing in Patients with Chronic Kidney Disease after FDA Label Change
Alvarez CA, presented a session at the American Diabetes Association (ADA) 2021 81st scientific sessions: virtual congress. Metformin’s label was changed by the FDA in 2016 to allow for initiation at estimated glomerular filtration rates of less than 45 mL/min/1.73 m2,
This study aimed to estimate the trends of incident metformin for type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) patients from 2010-2018. Trends of new metformin prescriptions in treatment naïve patients with T2DM and CKD from the Veterans Affairs from 2010-2018 were evaluated. As the number of new metformin prescriptions per 1,000 eligible patients, incidence was measured.
A total of 616,670 patients were eligible. Patients had a mean age of 68 (SD 11.1), 95.8% were male, and 72.2% were white. Increase in the number of prescriptions per 1,000 eligible patients was reported p<0.001. In addition, there has been an increase in metformin prescriptions, primarily in stages 3a and 3b vs. stage 4 and 5.
According to the study, increased trend was reported in new metformin prescriptions predominately in stages 3a and 3b.
Relationship between Time-in-Range and Laboratory HbA1c in Pregnant Women with Type 1 Diabetes Mellitus
Ling P, presented a session at the American Diabetes Association (ADA) 2021 81st scientific sessions: virtual congress. The goal of the study was to determine the correlation between time-in-range (TIR) and laboratory glycated hemoglobin A1c (HbA1c) in pregnant women with type 1 diabetes mellitus (T1DM).
From January 2015 to June 2018, pregnant women with T1DM who wore continuous glucose monitoring (CGM) system devices (iProTM2 system) in the first, second, and third trimesters, as well as postpartum, were enrolled in an observational study from 11 hospitals in China. TIR, time above range (TAR), time below range (TBR), mean glucose (MG), and glycemic variability (GV) parameters were calculated using data from the CGM system. The relationship between CGM metrics and HbA1c was investigated. The best-fitting model to account for the influence of gestational changes in HbA1c on the TIR-HbA1c relationship was investigated using linear and curvilinear regressions. Almost 272 CGM data and corresponding laboratory HbA1c from 98 pregnant women with T1DM, as well as demographic and clinical characteristics were estimated.
During pregnancy, the mean HbA1c and TIR were 6.49±1.29% and 76.16±17.97%, respectively. During pregnancy, HbA1c was moderately linked with TIR3.5-7.8(R=-0.429, P=0.001), mean glucose (R= 0.405, p=0.001) and the TAR7.8 (R=0.435, p=0.001), whereas, weakly linked with TBR3.5 (R=0.034, p=0.001). On average, a 1% (11 mmol/mol) difference in HbA1c corresponded to an 8.5% difference in TIR3.5-7.8. During pregnancy, HbA1c of 6%, 6.5% and 7% were equivalent to a TIR3.5-7.8 of 78%, 74%, and 69%, respectively.
A moderate correlation between HbA1c and TIR3.5-7.8 was observed during pregnancy. It was suggested that to achieve the HbA1c target <6% for pregnant women with T1DM, women and clinicians should aim for TIR3.5-7.8 >78% (18h 43min/per day), during pregnancy.
Early CGM Initiation Improves A1C in Youth with T1D: Teamwork, Technology, Targets, and Tight Control (4T) Study
CGM use is correlated with enhancement in A1c. It was hypothesized that initiation of CGM would enhance A1c in the 1st month following T1D diagnosis.
Prahalad P, presented a session at the American Diabetes Association (ADA) 2021 81st scientific sessions: virtual which compared A1c outcomes in the pilot group with those diagnosed from 2014-2016 (controls, n=272) who were not provided early CGM. Youth with newly diagnosed T1D from July 2018 to May 2020 (pilot group, n=122) were provided CGM initiation in the 1st month following T1D diagnosis (119 started CGM). A locally measured scatter plot smoothing was used to see the A1c trajectories (Fig). The differences in A1c trajectory were evaluated by group through interaction terms in a linear mixed model adjusted for baseline characteristics (age, sex, race and insurance type).
The mean A1c at diagnosis was greater in the pilot group (12.2 vs. 10.7%). The median age of diagnosis was 9.5 years [6.8, 13.3], 64% male, 38% non-Hispanic White, and 76% with private insurance in the pilot group. In this group, 89% patients were initiated CGM in the first 30 days following diagnosis than 2% in the control group. The pilot group showed lower mean A1c at 6 months (-0.81, p = 0.019), 9 months (-1.43, p = 0.013), and 12 months (-2.05, p = 0.012) post-diagnosis as compared to the historic group following adjusting for baseline characteristics.
Early initiation of CGM was correlated with a decreased A1c than those in a historic group. These evidence aid early initiation of CGM as standard of care in youth with T1D.
What We Know about How Insulin Works—100 Years Later
Ronald Kahn presented a study “What we know about How Insulin Works—100 Years Later” at American Diabetes Association (ADA) 81st Virtual Scientific Session.
InR and IGFR regulate overlapping but differential networks of protein phosphorylation. Both the extracellular and intracellular domains of IR and IGF1R have unique roles in these different networks of phosphorylation. Especially in different signaling is one amino acid at position 973 in the juxtamembrane domain. These receptors also create unique signals in the unoccupied states, i.e., in the absence of ligand, which regulates apoptosis and expression of imprinted genes and mRNAs.
Researchers are now able to define full spectrum signaling defects in T2D in iMyos using global phosphor proteomics. Extensive alterations were observed in the basal phosphorylation in type 2 diabetes myoblasts. An integrated signaling map of muscle insulin resistance in T2D and insulin-resistant non -diabetics was created. This was able to reveal the innate complexity of the condition.
iPS cells as a model for the study across the spectrum of resistance with the help of human donors with T2D. iPS cells were used to map the progressive pathogenesis of T2D and metabolic syndrome invitro.
iPS cells models may help to uncover the fundamental defect in T2D and metabolic syndrome as research continues down the line. Insulin resistance predicts or precedes the risk of T2D in offspring of T2D parents.
