The recent back and forth of the Diabetes UK Annual Professional Conference between Birmingham and Glasgow has finally ended and this years’ conference was in the splendid new Arena and Convention Centre in Liverpool. The conference halls and exhibition centre were in the same building and there was ample hotel space nearby. Overall, the conference worked very well and it remains to see if next year at the ExCel centre in London can match up.
The first highlight was a brilliant session on diagnosing diabetes using HbA1c levels instead of fasting blood glucose levels. In my opinion, this looks certain to come in but it is not without its problems, particularly in people with haemoglobinopathies, such as 3 million black Americans. There are significant variations in HbA1c measurements between ethnic groups, and not only is it expensive, but also some countries will not have the technology.
The launch of the Classification and Coding of Diabetes in Primary Care Working Group was accompanied by some excellent sessions. It seems that QOF has made us shoehorn people into one of two groups – type 1 or type 2 diabetes – and around the country this has resulted in huge variations in prevalence of type 1 diabetes, resulting in inappropriate management and psychological distress. The proposed new diagnostic system is simple and bases a diagnosis of type 1 diabetes on age and whether someone is treated with insulin within 6 months of diagnosis.
The Banting Lecture from Oxford Professor David Matthews was a superb indictment of the plague of destruction caused by modern life. Entitled Diabetes: The Black Death of the 21st Century, he demonstrated that diabetes mimics an infectious disease and proposed that the only way to stop it is through better education, consumption taxation and legally binding food labelling.
There were a couple of open discussion forums on the relative benefit of improving blood pressure and cholesterol compared with blood glucose. The bottom line for interventions is to first treat cholesterol; second, blood pressure; and third, blood glucose; and this differential becomes more marked with age (Cruickshank, 2010).
Given all the hype about insulin and cancer, it seems that diabetes and impaired glucose tolerance are associated with increased risk of mortality from cancer, and lo and behold, metformin is protective against cancer risk. There is still no proven link in humans between insulin and cancer (Gale, 2010).
- Good news: low vitamin D levels are associated with diabetes. Bad news: supplementation with vitamin D does not reduce the risk (Fraser, 2010).
- New dipeptidyl-peptidase-4 inhibitor, linagliptin, is hepatically excreted so it can be used in people with a low estimated glomerular filtration rate (Deacon and Holst, 2010).
- A sodium glucose co-transporter-2 inhibitor, dapagliflozin, is predicted to come out next year. It promotes glycosuria with few urinary tract infections and weight loss (Wilding et al, 2009).
- Long-acting glucagon-like peptide-1 receptor agonists: fortnightly, monthly and 3-monthly versions are on the horizon (Holman, 2010).
And finally, among all the talk of technical innovation, Fiona Kirkland reminded everyone that treating individuals and colleagues with true respect is what achieves results.