More Research Highlights From EASD 2020

The virtual European Association for the Study of Diabetes 2020 meeting featured new insights and developments in helping people with type 1 and type 2 diabetes improve glycemic control and related outcomes. Some of the new research presented included positive phase II findings for a once-weekly insulin option, shortened lifespans for people with type 1 and 2 diabetes, and the COVID-19 pandemic’s effect on glycemic control.

Below are highlights of several other noteworthy studies from the meeting.

Pancreas Restoration in Remission

People with type 2 diabetes who were able to achieve an HbA1c level under 6.5% and a fasting blood glucose under 126 mg/dL (7.0 mmol/L), and could get off all anti-diabetic medication saw a significant increase in pancreas volume after 2 years. Those who achieved remission had a pancreatic volume increase by 12.6±1.5 cm³ compared with 4.5±1.3 cm³ in those not able to achieve remission of their type 2 diabetes (P<0.0001).

Pancreas borders also normalized after 24 months of diabetes remission, the 64-person Diabetes Remission Clinical Trial (DiRECT) study found.

This restoration of pancreas morphology took some time, however, as remission of diabetes did not change pancreas volume after only 5 months (63.0±2.8 at baseline to 64.0±2.8 cm³, P=0.10).

“Large amounts of insulin cause tissues to grow, or at least maintain their size. Normally, inside the pancreas the amounts of insulin present after a meal are very high. But in type 2 diabetes this does not happen. This new study suggests that achieving remission of type 2 diabetes restores this healthy, direct effect of insulin on the pancreas,” explained the study’s lead author, Roy Taylor, MD, of Newcastle University in England, in a press release.

Pilots Given the Green Light

In an observational study in Europe of 49 pilots with either type 1 or type 2 diabetes, introducing a new color-coded glucose protocol effectively eliminated safety events.

The 49 pilots included in the study, who had all been granted medical certification to fly either commercial or non-commercial aircrafts, checked their blood glucose levels prior to the flight, hourly during the flight, and 30 minutes prior to landing. These values were then color-coded into a traffic light coding system: “green” (90-270 mg/dL), “amber” (low 72-88.2 mg/dL, high 271.8-360 mg/dL), and “red” (low <72 mg/dL, high >360 mg/dL).

In the event of a “red” reading, the pilot was required to immediately hand off flying responsibilities to a co-pilot or land the plane as soon as safely possible if flying alone.

During 22,078 flying hours, nearly 98% of glucose measures were within the green zone. In comparison, only 0.12% were in the low red range and 0.02% were in the high red range, according to the study, also published in Diabetes Care.

“There were no periods of pilot incapacitation throughout the whole study,” lead author Gillian Garden, MBChB, of the University of Surrey in Guildford, England, pointed out during a press conference. “We believe that the study is of international importance and this protocol could be adopted by other aviation authorities to allow more insulin-treated pilots worldwide to be able to fly commercial aircrafts.”

Tears Offer New Insight

In a possible alternative to invasive finger pricks, glycoalbumin levels in tears were found to be accurately representative of blood glucose levels.

In a study of 100 people with diabetes, glycoalbumin levels in tears, measured by liquid chromatography and mass spectrometry, were not influenced by the concentration or dilution of tears. A multiple regression model showed that the correlation between glycoalbumin levels in blood and tears was also maintained after adjustment for age, gender, nephropathy stage, and obesity (ß 0.738, 95% CI 0.594-0.882, P<0.001).

“In the future, we plan to optimize measurement conditions and develop measurement equipment, and to verify the effectiveness and usefulness of diabetes monitoring methods,” said lead author, Masakazu Aihara, of the University of Tokyo, during a virtual presentation of the poster study.