Why do you need to know about EASD

Why do you need to know about EASD and it’s activity? EASD annual conference in Munich, Sep 2016 Патракеева Евгения Михайловна Evgenya. patrakeeva@gmail. com

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Who or what is “EASD”? EASD is one of the largest networks for diabetologists worldwide with the mission to promote excellence in diabetes care through research and education. Aims are to encourage and support research in the field of diabetes, the rapid diffusion of acquired knowledge and to facilitate its application.

EASD Annual Meeting Attendance 2000 - 2016 24, 000 22, 000 20, 000 18, 365 18, 000 14, 000 10, 662 12, 000 8, 000 17, 462 18, 127 17, 895 17, 501 14, 656 16, 000 10, 000 16, 577 17, 301 12, 258 13, 098 12, 681 15, 575 15, 318 10, 069 7, 425 6, 000 4, 000 2016 Munich 2015 Stockholm 2014 Vienna 2013 Barcelona 2012 Berlin 2011 Lisbon 2010 Stockholm 2009 Vienna 2008 Rome 2007 Amsterdam 2006 Copenhagen 2005 Athens 2004 Munich 2002 Budapest 2001 Glasgow 2000 Jerusalem -

EASD Annual Meeting Abstracts Submitted and Accepted 3000 2, 498 2, 313 2500 2, 307 2, 165 2, 080 2, 063 2, 159 2, 321 2, 264 2, 145 2, 069 1, 927 1, 904 2000 1500 1. 360 1. 195 1. 250 1. 261 1. 402 1. 367 1. 352 1. 294 1. 360 1. 332 1. 209 1. 270 1167 1000 500 2016 Munich 2015 Stockholm 2014 Vienna 2013 Barcelona 2012 Berlin 2011 Lisbon 2010 Stockholm 2009 Vienna 2008 Rome 2007 Amsterdam 2006 Copenhagen 2005 Athens 2004 Munich 0

Why you should be a member of EASD unites knowledge from all over the world Annual Meeting with over 15, 000 participants Journal “Diabetologia” is one of the leading publications in the field EASD Foundation offers support in all areas of diabetes research Courses and workshops for education and networking Recognising of scientific excellence: the Albert Renold Prize, the Camillo Golgi Prize, the Claude Bernard Prize, the Minkowski Prize and the EASD-Novo Nordisk Foundation Diabetes Prize for Excellence • EASD Study groups • • • EASD is the home of diabetes research in Europe

EASD Study Groups Ø Ø Ø Ø Ø Artificial Insulin Delivery, Pancreas and Islet Transplantation Study Group (AIDPIT) Diabetes and Cancer Study Group Diabetes Education Study Group (DESG) Diabetes Pregnancy Study Group (DPSG) Non-alcoholic fatty liver disease (NAFLD) Diabetes Neuropathy Study Group (NEURODIAB) Eye Complication Study Group (EASDec) European Diabetic Nephropathy Study Group (EDNSG) Incretin Study Group Islet Study Group European Diabetes Epidemiology Group (EDEG) Diabetes and Nutrition Study Group (DNSG) Psychosocial Aspects of Diabetes Study Group (PSAD) Diabetic Foot Study Group (DFSG) Study Group on Metabolic Imaging Study Group on Primary Care Research in Diabetology (PCDE) Study Group on Genetics of Diabetes (SGGD) Diabetes and Cardiovascular Disease Study Group Exercise and Physical Activity Study Group (Ex. PAS) Reactive Metabolites (RMSG)

EASD Postgraduate Courses offer hands-on training • We strive to cover as many topics as possible • We use real patients and show real techniques for treatment and care • We work with scientists and medical professionals, politics never plays a role, we are a non-governmental organisation • We are encouraging young professionals to enter the field of diabetes • We are developing the future of diabetes, diabetes research and diabetes care

Results from the delegate survey Which of the following titles describes your current professional activity best? Academic/Research 31% 27% Corporate/Industry Hospital 25% General Practicioner 13% Private Practice 12% 2% Other 0% 5% Relative to 1. 695 answers, multiple answers possible 10% 15% 20% 25% 30% 35%

Results from the delegate survey Why do you attend the EASD Congress? Education 66% 38% Networking New therapies / diagnostics 37% General meetings 20% CME certificate 7% 0% 10% Relative to 1. 712 answers, multiple answers possible 20% 30% 40% 50% 60% 70%

Results from the delegate survey Which session formats are most interesting for you? Oral presentations 70% 36% Interactive sessions Industry Symposia 29% Posters 28% Hands-on Sessions/Workshops 20% 0% 10% Relative to 1. 607 answers, multiple answers possible 20% 30% 40% 50% 60% 70% 80%

Results from the delegate survey Will you attend next years EASD Annual Meeting? 100% 92% 90% 80% 70% 60% 50% 40% 30% 20% 8% 10% 0% Yes Relative to 1. 463 answers No

Abstract Review Process

EASD Virtual Meeting Global reach

Among the highlights this year: • SUSTAIN-6: Positive CV outcomes with investigational GLP-1 agonist semaglutide • Libre Flash Glucose Monitoring System triples rate of self-monitoring • Perinatal death increased at full term with gestational diabetes • Startling results refute the notion that type 1 diabetes is a "juvenile" condition • "One-Stop Shop" for diabetic neuropathy and retinopathy screening • Promising first data on GLP-1 agonist/SGLT 2 inhibitor combo • More LEADER: Liraglutide delays progression of renal events

https: //www. easdvirtualmeeting. org

Another Positive CV Outcomes Trial for Diabetes Drug: SUSTAIN-6 • A second glucagon like-peptide 1 (GLP-1) agonist has shown positive results in a major cardiovascular-outcomes trial in type 2 diabetes patients at high risk of cardiovascular disease. • In the SUSTAIN-6 trial, patients treated with one of two doses of the investigational agent semaglutide (Novo Nordisk), administered weekly, had a significant 26% lower risk of the primary composite outcome of first occurrence of CV death, nonfatal myocardial infarction, or nonfatal stroke over 2 years compared with those on placebo. • Semaglutide also led to significant and sustained reductions in Hb. A 1 c levels.

The main results of the 3200 -patient trial conducted in 22 countries were simultaneously published online in the New England Journal of Medicine

'Flash' Glucose Monitoring

Пациент Е. , 4 года, СД 6 мес. Hb. A 1 c 7, 8%

Использование уровня интерстициальной глюкозы Rebrin, Kerstin, Garry M. Steil et al. , Am. J. Physiol. 277 (Endocrinol. Metab. 40): E 561–E 571, 1999

Libre 'Flash' Glucose Monitoring System Cuts Hypoglycemia • Use of the Freestyle Libre Flash Glucose Monitoring System (Abbott Diabetes Care) significantly reduces hypoglycemia without raising Hb. A 1 c levels in insulintreated diabetes patients, compared with self-monitoring of blood glucose using finger sticks. • "When the patients started using the Libre device, they instantly tripled their rate of self-monitoring, and this resulted in a marked reduction in time and events spent in hypoglycemia, time spent in hyperglycemia, an increase in time spent in optimum range, less glucose variability, and improvements in quality-of-life measurements, ” - Jan Bolinder, Karolinska Institute, Stockholm, Sweden. • The Libre system comprises a small round glucose sensor worn for up to 14 days on the back of the upper arm and a scanner device that the patient waves over the sensor to get a reading of glucose concentrations in the interstitial fluid. • The scans display both historical and current glucose trends. The Libre system is now available in 28 countries, with almost 200, 000 users globally.

Gestational Diabetes: Baby Death Increased at Full Term • A large French cohort study found a 30% increased risk of perinatal death in mothers with gestational diabetes who gave birth after 37 weeks, compared with the risk in nondiabetic mothers. • This higher risk of the baby dying was the same regardless of whether the woman was treated with insulin for the gestational diabetes or not. • However, it was still lower than the risk of perinatal death in mothers with either type 1 diabetes or type 2 diabetes • "This increase in perinatal death, particularly in women with untreated gestational diabetes that we see here, is new. It is often thought that those with untreated gestational diabetes are less severe and might have lower risk of poor perinatal outcome”

Half of All Type 1 Diabetes Develops After 30 Years of Age • Onset of type 1 diabetes is just as likely to occur in people older than age 30 as in those younger • Obtained using genetic data from the UK Biobank, the startling results refute the long-held belief that type 1 diabetes is primarily a "juvenile" condition. • Clinically, the findings are particularly relevant for primary care, where people who develop autoimmune-mediated diabetes in adulthood are often misdiagnosed as having type 2 and prescribed metformin instead of insulin. • "I think it's an eye-opener and obviously has implications for how we diagnose and manage people and also the education people receive. We very much focus on childhood and adolescence and perhaps people diagnosed later don't get the same education”

'One-Stop Shop' for Diabetic Neuropathy Along With Eye Screening • Assessing patients for diabetic neuropathy while they are having their eyes examined may be a quick and convenient way of identifying early those who are at risk of nerve damage. • Anyone pinpointed could be referred to a special clinic for aggressive risk-factor management • "one-stop shop” (Sheffield), whereby diabetes patients coming for retinopathy screening also have their feet assessed using two new state-of-the-art point-ofcare devices. These are the DPNCheck (Neuro. Metrix) — a handheld device that takes 3 minutes to provide a reading and assesses large-fiber nerve-conduction velocity and amplitude — and Sudoscan (Impeto Medical), a device that assesses small nerve fibers, also in about 3 minutes

Insulin Users Can Be Safe Pilots (When Following a Protocol) • Insulin-treated diabetics can be safe air pilots (data from the United Kingdom) • In 2012, the UK became only the second country in the world (after Canada) to issue class 1 medical certificates for commercial pilot licenses (CPLs) to people with diabetes who use insulin (or sulfonylureas/glinides) and who are deemed low risk and follow a set protocol for glucose monitoring and adjustments. • About 70 people have been granted such CPLs thus far, and data for 26 of those individuals were presented by Dr Julia Hine, United Kingdom. • Over an average follow-up of nearly 2 years, more than 95% of glucose readings were in the designated "safe" range of 5 to 15 mmol/l (90– 270 mg/d. L), and no episodes of pilot medical incapacitation due to low or high blood sugar were reported. • Key to the program's success is a comprehensive protocol developed by a panel of medical and aviation experts governing the medical certification of insulin-treated pilots and based on available literature regarding hypoglycemia risks and experience from various transport modalities.

First Data on GLP-1 Agonist/SGLT 2 Inhibitor Combo in Diabetes • Combining exenatide (Bydureon, Astra. Zeneca) with dapagliflozin (Farxiga/Forxiga, Astra. Zeneca) improved glycemic measures and CV risk factors more so than each drug alone in patients with type 2 diabetes inadequately controlled on metformin monotherapy in the DURATION-8 trial. • The study provides the first evidence of efficacy of coadministration of a combination of a glucagonlike-peptide 1 (GLP-1) receptor agonist (exenatide) and a sodium glucose cotransporter 2 (SGLT 2) inhibitor (dapagliflozin) • The dual treatment regimen was well tolerated, with the expected safety profile for this combination.

Aspirin Overuse May Exceed Underuse in Diabetes • Aspirin has been overused more often than it has been underused as primary prevention for cardiovascular disease in patients with diabetes, according to a new analysis of electronic health record data from a large primary-care setting. • The data also reveal that underuse of aspirin for primary prevention has been more of a problem than overuse in people with reversible CV risk factors who don't have diabetes.

More LEADER: Liraglutide Delays Progression of Renal Events • The glucagonlike-peptide 1 (GLP-1) agonist liraglutide (Victoza, Novo Nordisk) delays progression of renal events — in particular, new-onset persistent macroalbuminuria — in patients with type 2 diabetes, according to the latest data from the LEADER trial. • "On top of standard therapy, this GLP-1 agonist [liraglutide] reduced microvascular outcomes, particularly renal ones” - Dr Mann. He emphasized that the main driver for the microvascular outcomes was new and persistent macroalbuminuria, with a risk reduction of 26% seen with liraglutide compared with placebo (both on top of standard therapy).

Global Study Examines Depression With Diabetes • New research on a global scale shows high rates of depressive disorder (10%) in patients with type 2 diabetes, but with wide variations between countries. • Depression affected almost 30% of type 2 diabetes patients assessed in Bangladesh, with Mexico, Russia, and Poland also scoring highly, according to early findings from the International Prevalence and Treatment Study (INTERPRET-DD) • The study is following 3000 patients in 15 countries in terms of a recorded diagnosis of depression and prescribed medication or therapy and

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