EASD wrap up: It’s all about insulin

Our little team just got back from Amsterdam where we went to find out about diabetes research in Europe. For us, it was a great week for science and learning at EASD and we feel lucky this is part of our job. The most important newsworthy event at EASD was the interim report by the Treating to Target in Type 2 Diabetes (4-T) Study Group, comparing mix, prandial (mealtime), and basal (long-acting) insulin analog regimens for the treatment of type 2 diabetes. Overall, all three insulins worked less well than had been imagined by many of the doctors and educators with whom we spoke, with only 8-24% of patients in any of the groups reaching the A1c target of 6.5%. Admittedly, 6.5% is a very big goal for which to aim, and they all began at a starting place of ~8.5%. The results of the 4-T study, as well as the conclusions for several other talks at EASD, do suggest that more combination therapy for type 2 patients is needed to reach ever-tighter targets - probably not JUST Lantus alone, not Novolog alone, not metformin alone, etc - it might work for a bit but it won't work forever (that said - Novolog alone worked the best, suggesting that the more one takes insulin, the better one does - so wouldn't a pump be best!?). We think this study bodes well for the GLP-1 drugs (Exenatide, Liranglitide) and to some extent for the the DPP-4 inhibitors (Januvia and in Europe, Galvus), which are in some quarters replacing sulfonylureas as an add-on of choice (at least, where insurers are willing to pay for them - more places than might have been expected!). The other theme this year that really seemed to resonate was, in addition to combination therapy, earlier, more aggressive, and more personalized therapy - figuring out what fits each patient best. Here, simple is best, because we all have to get our therapy in such a hurry, at least here in the US.

Attending EASD was also an excellent opportunity to compare diabetes care in Europe to diabetes in the US. Compared with ADA, we found EASD had slightly less of a focus on drugs, and more of a focus on basic science and insulin initiation (this is also clearly due to 4T this year!). We surveyed endocrinologists at both ADA and EASD, and while the results of our EASD survey are not available yet, it was very striking to us just how unfamiliar many of the people we surveyed were about new drugs, particularly DPP-4s and GLP-1s. Many people said the drugs were not available in their country, or were not on the formulary yet – in most cases, they have been approved but not launched, but the doctors were likely not aware of the approvals. Many others said that the drugs were available but they had not prescribed them yet. One physician from England appeared a little embarrassed about his lack of experience using DPP-4s and GLP-1s, but he joked, “We do have insulin, which Americans seem to forget about…” 

While we loved every moment of the conference, nothing beat the walk to and from ...

 

Comments

[Kevin McMahon]

It just occurred to me at the end of your post that perhaps the biggest difference between ADA and EASD has to do with lifestyle itself. You mentioned how much you enjoyed your walks to and from the event and at ADA it was all about taking bus transport to/from downtown Chicago. In American lifestyle in general (with the exception of people living in San Francisco and a few other cities like it), nobody walks anywhere unless they purposefully "go for a walk" or funnier still drive to the shopping mall to "go walking". Maybe we can work on a reimbursement code for activity, too.

Thanks for your great reporting Kelly and team.