The global diabetes community met in Stockholm to benefit from the latest research and innovations in the field of diabetes. At the 58th Annual Meeting of the European Association for the Study of Diabetes, body weight was the focus of consideration. However, findings on the relationship between type 1 diabetes and enteroviruses were also discussed.
The body mass index (BMI) as a unit for classifying body weight is always under discussion. New findings show that alternative measures are preferable, especially for risk assessment regarding overweight and obesity. For this purpose, a direct comparison of waist-to-hip ratio (WHR), body mass index (BMI), and fat mass index (FMI) was conducted in the United Kingdom in a total of more than 380,000 residents. It was shown that WHR had the strongest and most consistent relationship with total death compared to the other two masses. This suggests that clinicians should pay more attention to obesity distribution than BMI when prioritizing obesity interventions.
Live longer thanks to whole grains
The results of a systematic review and meta-analysis have brought to light that higher consumption of whole grains, fish, fiber, and omega-3 polyunsaturated fatty acids reduces mortality in people with type 2 diabetes. Consumption of about 20 g of whole-grain products such as whole-grain bread, brown rice, or breakfast cereals per day was associated with a 16% reduction in all-cause mortality. Each serving of fish consumed per week reduced the risk of all-cause mortality by 5%. Consumption of 5 g of dietary fiber daily was associated with a 14% reduction in all-cause mortality, and 0.1 g of omega-3 polyunsaturated fatty acids per day was associated with a 13% reduction.
Long-term glucose monitoring for all diabetics?
Continuous glucose monitoring (CGM) has so far been reserved mainly for people with type 1 diabetes or people with type 2 diabetes who are on intensive insulin therapy. Now it has been discussed whether it could also be useful for all diabetes patients. The benefits in type 1 diabetes are now extensively documented. Current results show a 0.5 percentage point greater reduction with CGM than with standard fingerstick measurement in 156 participants with an average baseline blood glucose level of 8.6% after 24 weeks. A 7-year follow-up study published in January confirmed that initiation of CGM within 1 year of diagnosis of type 1 diabetes leads to improved long-term HbA1c compared with starting later or not at all.
Blood glucose could also be lowered with CGM in patients with type 2 diabetes if they received multiple insulin injections daily. In addition, in a single-arm study of adults with type 2 diabetes treated with basal insulin only or with therapy without insulin, six months of CGM use significantly improved measurement time and HbA1c levels, regardless of the number of medications patients were taking. Similarly, real-world data in 1440 adults with type 2 diabetes without intensive insulin therapy showed that CGM resulted in significant reductions in HbA1c, BMI, and severe hypoglycemia. There is growing evidence that CGM also improves glycemic control in type 2 diabetes under less intensive hypoglycemic therapy. Therefore, the use of CGM in this patient group is expected to increase.
Type 1 diabetes and enteroviruses
Enteroviruses are a large family of viruses that live in the digestive tract and are responsible for many infections in children. There are more than 70 different strains, including coxsackieviruses of groups A and B, polioviruses and hepatitis A virus, among others. New research now shows that enterovirus infection appears to be closely associated with both type 1 diabetes and islet cell autoantibodies. The analysis focuses on studies using more modern molecular techniques to detect viruses, including high-throughput sequencing and single-cell technologies. The analysis identified 60 studies with a total of 12,077 participants, 900 of whom had islet autoimmunity, 5081 of whom had type 1 diabetes, and 6096 of whom had a control group. The association between enterovirus infection and islet autoimmunity was greater in individuals who later developed type 1 diabetes, with an odds ratio of 5.1 versus 2.0 in those who did not develop diabetes. The strength of the association, particularly within the first month of diagnosis of type 1 diabetes, supports the rationale for developing enterovirus-targeted vaccines and antiviral therapies to prevent and reduce the impact of type 1 diabetes. The findings also raise the question of whether people should be routinely tested for enteroviruses at the time of diagnosis of type 1 diabetes.
Congress: EASD 2022
CARDIOVASC 2022; 21(4): 44
