Georg Röggla at the 45th meeting of the EASD

Georg RögglaThe 45th annual meeting of the European Association for the Study of Diabetes (EASD) took place in Vienna, Austria, from September 30th to October 2nd  The town centre and all places of interest were flooded with the bright red congress-rucksacks.

The first main point of interest focused on the possible association between cancer and insulin therapy. The discussion whether insulin analogues could cause cancer had been stirred up in the weeks before the meeting. Edwin Gale, the UK editor of Diabetologia, told the audience that breast cancer mortality was 50% higher in diabetic subjects and the risk of a cancer in the pancreas was 5 times as high. Whether was due to insulin resistance in type 2 diabetics or to insulin therapy is not known. Jay Skyler, USA and David Russel-Jones, UK both reported that there was no convincing evidence for an elevated cancer incidence during a therapy with the long acting insulin analoga. Jeffrey Johnson from Canada advised cautious therapy with high doses of insulin or therapy with sulfonylurea. Ulf Smith from Sweden pointed out to a possible protective effect of a therapy with metformin on cancer incidence. So at the moment we don’t know if obesity and insulin resistance or diabetes therapy are to blame for the undisputed elevated cancer incidence in diabetics. The representatives of pharmaceutical industry looked slightly relieved.

The second main point of interest was the struggle for clearly defined therapy targets in type 2 diabetes.   The Accord trial about a year ago had destabilized the dogma to target normal glycated haemoglobin levels because of increased mortality and no significant reduction of mayor cardiovascular events.   Andrea Siebenhofer-Kroitzsch from Austria , presented a meta analysis on this topic and concluded, that only young patients should target a normal Hb1ac level, whereas in old patients a Hb1ac level of 7,0 % or perhaps even 7,5 % is acceptable. These Patients would gain much more benefit from an optimal therapy of hypertension and of hyperlipidaemia.

The third main point of interest was stimulated by a joint statement on the EASD website calling attention to the excess cardiovascular mortality associated with severe mental illness by the European Society of Cardiology, the EASD and the European Psychiatric Association. Richard Holt from the UK drew attention to the fact that people with schizophrenia and bipolar disorder die prematurely, on average 10 to 20 years earlier than the general population. Suicide and trauma are well-recognized causes of death among such patients, but physical illness accounts for 75% of mortality, and cardiovascular disease is the commonest cause of death. It’s becoming more and more apparent that not only do these people have mental disease, but they are at a considerably high risk of cardiovascular disease and of developing diabetes.

Georg Röggla is an associate editor with the BMJ.