American Diabetes Association 2014

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Last month BMC Endocrine Disorders was in San Francisco to attend the 74th Scientific Sessions of the American Diabetes Association (ADA); one of the largest and most prestigious conferences in the field of endocrinology.

Extremely well organised, the conference was attended by over 17,000 clinicians and scientists from 121 countries across the globe. With such an international audience it was thoughtful of the organisers to create a ‘World Cup Lounge’ so that everyone was able to keep in touch with the action in Brazil.

A wide range of talks were presented at the conference covering clinical medicine as well as basic science. An early highlight came from researchers on the ORIGIN, ACCORD and VADT studies which examined the relationship between hypoglycaemia and cardiovascular disease. These studies showed that tighter glycaemic control was associated with an increased risk of hypoglycaemic episodes. However the researchers argued that, although patients with intensive glycaemic control were at a higher riskof hypoglycaemia, these episodes were less likely to result in cardiovascular harm. One explanation put forward was that frequent hypoglycaemic episodes may pre-condition cardiac tissue to resist damage.

One of the main themes of the conference was a focus on the individual patient and the need for clinicians to treat patients as partners in their treatment. During a talk by the authors of the Diabetes Prevention Program Outcomes (DPPOS) Study it was emphasised that lifestyle modification has a tremendous effect in people at high risk of type 2 diabetes, and it is possible to delay the onset of diabetes. However adherence rate for these strategies is poor and, as discussed in a talk by William Polonsky, an exclusive focus on behaviour modification may in fact demotivate patients. To this end, several talks focused on the importance of recognising the individual needs and circumstances of each patient and to collaborate with them to develop goals that patients consider worthwhile and are more likely to achieve. Talks from Peter Katzmarzyk, Martin Gibala and Luc Van Loon underscored the importance of exercise and how intensity, timing and frequency can be tailored to individual needs to improve outcomes in T2DM patients. Related to this topic, David Marrero discussed the impact of communities on health outcome in people with diabetes and the effect of community programs on changing health behaviours. Heather Stuckey also presented data from the DAWN and DAWN 2 studies examining the social context for quality of life scores in people with diabetes and the need for people with diabetes to receive support from family members in order to improve self-management behaviours.

During the meeting, Daniel Drucker was awarded the Banting Medal for scientific achievement and his lecture “Deciphering metabolic messages from the gut drives therapeutic innovation” proved to be a highlight of the conference. During his talk, Prof Drucker discussed his career to date, and his many achievements with his translational work on GLP-1 and GLP-2.

Another excellent talk was delivered by Joel Elmquist, who received the award for outstanding scientific achievement. In his lecture “Claude Bernard was right – brain control of glucose homeostasis” Prof Elmquist discussed his research into the role that hypothalamic proopiomelanocortin neurons play in the control of glucose homeostasis and the transgenic methods that enable his research group to selectively knock out genes in selected hypothalamic neurons.

The conference ended with an address from the President of the ADA, Prof Elisabeth Seaquist. In her talk, Prof Seaquist highlighted the progress that had been made in the fight against diabetes within the past twenty years and the immense contribution that the ADA had made. However, the incidence of diabetes is rising worldwide and Prof Seaquist warned that this progress that has been made is now being threatened by decreases in funding for research. Prof Seaquist argued that, in this climate, a transformational change is required for the ADA to achieve its mission of curing and preventing the disease. To approach this issue the ADA has recently implemented the “Pathway to stop diabetes” program and aim to provide funding and support for outstanding young researchers. To combat diabetes, Prof Seaquist called upon all attendees to take a greater role in supporting the ADA, increasing awareness of the disease and to advocate for increased funding at both a local and federal level.