Top 3 learnings from the ADATS and ADC Conference – Perth, August 2024

Remission of Type 2 Diabetes

Although not a new topic, new research findings from an Australian based trial was presented.
It was previously thought that a diagnosis of type 2 diabetes was permanent. But evidence suggests that type 2 diabetes may be able to be put into remission through significant weight loss.
What is meant by remission? Type 2 diabetes remission occurs when your long-term blood glucose level falls below the diabetes level and stays there for at least three months, without the need for glucose-lowering medication. In medical terms, this means having a HbA1c below 48mmol/mol or 6.5%.
DiRECT-Aus was an Australian research study replicating the DiRECT study conducted in the UK. It was hoped it would show that diabetes remission is possible and that it can be achieved through a structured weight management program using very low energy diets (VLED) delivered within general practice.
In the DiRECT-Aus trial, it was found that 85% of people who were diagnosed as having type 2 diabetes, who could reduce their body weight by more than 15% by using VLEDs, were able to achieve remission from type 2 diabetes. It is important to note that even with significant weight loss, not all participants were able to achieve remission. These results were consistent with what was achieved in the UK trial.
People less likely to achieve remission included those who had been diagnosed as having type 2 diabetes for a longer duration or were older in age.
If achieving remission of type 2 diabetes is something of interest to you, please discuss this with your diabetes health care provider as you will need guidance and support from health professionals to do this safely. 

Use of adjunctive therapies in type 1 diabetes management

The use of glucose lowering medication other than insulin was once thought to only benefit people living with type 2 diabetes. More recently, these treatments are being used alongside insulin therapy in people living with type 1 diabetes to enhance the effect of insulin and help to improve management. The use of these medications does not replace the need for insulin injections.

Metformin - Metformin helps reduce insulin resistance and can result in a small reduction in HbA1c, reduction in Total Daily Dose (TDD) of insulin and small amount of weight loss.

GLP-1 Receptor Agonists - Medications from the GLP-1 receptor agonist family such as Ozempic, are being used on private script by some people living with type 1 diabetes to help achieve weight loss and reduce their insulin requirements.

SGLT2 inhibitors - Medications from the SGLT2 inhibitor family work by allowing glucose to be filtered out through the kidneys in urine. Research has shown some benefits for using this medication including weight loss, improved time in range (TIR) on continuous glucose monitoring CGM and possible reduction in protein (or albuminuria) being leaked by the kidneys.

The use of these medications does however put people at increased risk of certain genital infections and diabetic ketoacidosis (DKA).
There are a few clinical diabetes trials currently underway to further explore the benefits of these medications for people with type 1 diabetes.
If you live with type 1 diabetes and are keen to learn more about these treatments, then please check if you are eligible for a clinical trial or discuss with your endocrinologist.
Trials https://jdrf.org.au/clinical-trials/

Steatotic Liver Disease in people living with type 2 diabetes

Steatotic liver disease (SLD) is commonly known as fatty liver disease.
Around the world, 25-30% of the adult population are estimated to have this condition. People who live with type 2 diabetes will have rates higher than this.
New guidelines indicate that all people who live with type 2 diabetes should be assessed for having SLD by their GP.
If you are unsure, ask your GP at your next appointment if you have been screened for SLD or diagnosed with this.
You can read more about SLD in the October edition of Membership Matters here or this article from LiverWell. 
If you have further questions about any of these topics, please speak with your GP, diabetes treating team or call the NDSS Information line on 1800 637 700 and ask to speak with a health professional.