News from the ADA Conference in New Orleans, June 2009

Joy Pape

Jun 30, 2009

Joy Pape gives us her Top 5 from this month's ADA conference.

Every time I return from the American Diabetes Association (ADA) Scientific Sessions conference, my head is so full of information that I need a week or two to sort through it. But now I've had a chance to choose what I think are the top five things that you need to know. Here they are...

Diabetes diagnosed using the A1c assay
An international expert committee assembled by the ADA, the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) is recommending the A1c assay as the new test for the diagnosis of diabetes. At this time, the two tests used to diagnose diabetes are the fasting plasma glucose test (a fasting blood glucose done in the lab, not on your meter) and the oral glucose tolerance test (OGTT). David M. Nathan, MD, Director of the Diabetes Center at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School, chaired the Expert Committee. He stated, " A1c values vary less than FPG values, and the assay for A1c has technical advantages compared with the glucose assay. Testing for diabetes using A1c is more convenient and easier for patients, who will no longer be required to perform a fasting or oral glucose tolerance test." The three organizations have not yet fully endorsed this change. Stay tuned...

For people with type 1 diabetes, it's not all about what you do: Genes play a role too
We've long known that people with type 1 diabetes have more glucose variability than people with type 2. Now a new study has proven it. Extensive data for the study were taken from the DCCT, a large landmark study of people with type 1 diabetes. Dr. Andrew D. Paterson, MBChB, lead author of the study and Senior Scientist in the Program for Genetics and Genome Biology at the Hospital for Sick Children in Toronto, said, "We identified four genes related to glycemic control in type 1 diabetes, Two of these genes also affect risk for complications-kidney, eye, and cardiovascular disease-and one gene has a strong effect on the rate of hypoglycemia." This does not mean that you can say, "It's all in the genes, so why take care of my diabetes?" But it does give you more ammunition to stop blaming yourself when you've done everything right and you still get a blood glucose number that doesn't make sense.

Follow-up from the ACCORD study, in which mortality was higher in intensively treated type 2s who were aiming for an A1c of less than 6%
At this time, it seems that lowering the A1c itself is not associated with increased mortality. Hypoglycemia may have been the culprit instead, and how quickly blood glucose was lowered may have had something to do with it as well. All is not clear yet, however, and we continue to learn. Stay tuned.

A new and different type of medication approved by the FDA for type 2 diabetes
There was a lot of buzz about a "new guy" in town, Cycloset. Cycloset is bromocriptine, which in lower doses is used to treat people with Parkinson's disease and other diseases. In type 2 diabetes, it has been shown to decrease insulin resistance. Cycloset is not yet available, but again...stay tuned.

More than an A1c; GlycoMark
GlycoMark is a simple blood test, approved by the FDA, that is used to measure glucose control in people with diabetes. It's very different than the A1c because it shows more than an average-it also shows glucose variability. GlycoMark provides a much more sensitive measure of variation over a one- to two-week period, rather than an average of two to three months. Dr. Irl Hirsch, Professor of Medicine at the University of Washington School of Medicine, stated, "The A1c is helpful in tracking broad glucose targets, but it only tells part of the story because it masks glucose variability. I would be concerned if a patient has an A1c level that is within target, but a GlycoMark score that is abnormal. There may be a risk for life-threatening hypoglycemia, and I can immediately explore where therapy changes need to occur. GlycoMark is a critical adjunct to A1c testing and presents a new paradigm for effective diabetes management." You don't have to wait for this test-just ask your healthcare provider about it. (Or it may be that you need to tell, rather than ask.)

I hope that you learned something from my top five to help you better manage your diabetes.

Joy Pape RN, BSN, CDE, WOCN, CFCN, has worked with Diabetes Health for years as a columnist, guest editor, and contributor. She has a private practice in New York City and is co-author of the book Real-Life Guide to Diabetes.

Categories: A1c Test, Blood Glucose, Community, Diabetes, Insulin, Low Blood Sugar, Research, Type 1 Issues, Type 2 Issues

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News from the ADA Conference in New Orleans, June 2009

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