EASD 2023: A Deeper Dive Into Type 1 and Type 2 Diabetes

HAMBURG, Germany — This year’s meeting of the European Association for the Study of Diabetes (EASD) offers an in-depth look into "disease-modifying and disrupting therapies" in both type 1 and type 2 diabetes. 

Noteworthy at the EASD meeting, taking place October 3-6, 2023, in Hamburg, Germany,

• will be final detailed data from the SURMOUNT-4 trial of the "twincretin" tirzepatide (Mounjaro, Lilly) on obesity. The top-line results, announced by the company in July, showed an average 21.1% weight loss at 36 weeks with tirzepatide injections once weekly among adults with overweight or obesity.

- The drug is approved in the United States and Europe for treating type 2 diabetes, and approval for obesity is expected in the US later this year.

In addition,

• a symposium will present a new EASD/American Diabetes Association (ADA) consensus report, Hyperglycaemic Crisis in Adult Patients with Diabetes, scheduled to be simultaneously published in Diabetologia and Diabetes Care on October 6, 2023.  

Aside from those, much of the EASD meeting content will feature smaller studies on both type 2 and type 1 diabetes, along with award lectures, symposia, debates, and lots of discussion on hot topics in diabetes and clinical challenges including complications. In essence,

- it will provide a forum for in-depth follow-up to the jam-packed clinical trial-filled agenda at the ADA meeting in June, said EASD Honorary Secretary Tina Vilsbøll, MD, clinical professor and head of clinic at the Steno Diabetes Center, Copenhagen, Denmark.

"There were so many large trials at ADA that we just took them in without really having a chance to discuss There’s so much to discuss with all these new treatments, how do we place them in obesity and diabetes? All the data that we have from ADA will make good discussions at EASD," Vilsbøll told Medscape Medical News.

Indeed, said EASD President Chantal Mathieu, MD, PhD, chair of Endocrinology at the University Hospital Gasthuisberg Leuven, Belgium, "We always come after ADA. That puts us in a position where we can take deeper dives into the date EASD is a calmer meeting where you can really look at the details."

Type 2 Diabetes: Disease Modifying in Many Ways 

Mathieu told Medscape that a unifying theme for much of the EASD meeting’s content is "

- We are now entering the era of disease-modifying and disease-disrupting therapies" in both diabetes types.

In type 2, this means "getting to the root, which is obesity, so you’ll see a lot of presentations on the incretin system, but you also don’t get type 2 diabetes if you have an iron-clad beta cell. So, we also gave a lot of attention to basic translational research that helps us to understand the role of the beta cell in type 2 diabetes."

In addition to SURMOUNT-4, there will be oral abstract sessions with follow-up data from the SURPASS series of studies of tirzepatide in type 2 diabetes, other abstract sessions, symposia about incretins and obesity, and an oral abstract session on beta cell function in both diabetes types.

• • Three debates will address controversial questions in the type 2 diabetes arena. In one, speakers will take opposite sides on "Initial combined therapy for type 2 diabetes: Should diabetes follow hypertension?"

In another, speakers will argue over "Is lasting remission of type 2 diabetes feasible in the real-world setting?" That’s an important question, Vilsbøll said.

"A person might be able to have a remission but go back if they regain the weight. Do we really have remission? How do we define it? Now, suddenly, we have tools to help people go in the right direction. Now we’re in a place where we can actually help our patients with their cravings and their body weight and all that. It’s more fun to discuss when we have the tools."

• A third debate will tackle the question of whether all people with type 2 diabetes and chronic kidney disease should be on [sodium-glucose co-transporter 2] (SGLT2) inhibitors "by default."

The Minkowski Prize Lecture will address the regulation of energy and glucose metabolism by the dual incretin receptor agonists, while the EASD-Lilly Anniversary Prize Lecture will be about the role of ectopic lipid in insulin resistance and cardiometabolic disease.

Type 1 Diabetes: Both Disease Modifying and Disruptive 

For type 1 diabetes, "disease-modifying" and "disruptive" approaches on the meeting agenda include new data on immune modulation for people in early stages in order to prevent or delay insulin dependence, islet transplantation including the use of stem cell–derived beta cells, and the latest in technology including automated insulin delivery systems, also known colloquially as the "artificial pancreas."

Prize lectures about type 1 diabetes will include the Claude Bernard Lecture, on etiologies of autoimmune diabetes, the Albert Renold Lecture, on "disrupted RNA editing as a path to type 1 diabetes," and the EASD/Novo Nordisk Foundation Diabetes Prize for Excellence Lecture on automated insulin delivery.

Focus on Complications: the Known and the Emerging

The meeting will also focus a great deal on complications of diabetes, including the well-studied cardiovascular disease, neuropathy, nephropathy, retinopathy, and fatty liver disease as well as others that typically receive less attention, such as gastrointestinal problems and cardiomyopathy.

Another debate will address the question "Is it time to reclassify diabetes complications because microvascular and macrovascular classification is no longer sufficient?"

And, the Camillo Golgi Lecture will cover "Diabetes Complications: From Classical to Emerging."

As always, there’s much more on the agenda including pregnancy and diabetes, cystic fibrosis-derived diabetes, mental health in diabetes, COVID-19 and diabetes, hypoglycemia, and hypoglycemia unawareness.  

According to Vilsbøll, "Clinicians should come and enjoy all the great science we have, interact, and be inspired."

From www.medscape.com

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