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Highlights From the American Diabetes Association’s Scientific Sessions
By Janice H. Dada, MPH, RD, CSSD, CDE, CHES

The American Diabetes Association (ADA) welcomed approximately 17,000 people to the 70th Annual Scientific Sessions in Orlando, Fla., in June. More than 13,000 of the attendees were healthcare professionals from around the world who wanted to learn the latest in research, treatment, and education. The following are some highlights from this year’s meeting:

Patient-Centered Care Model
The presidential address, delivered by Richard M. Bergenstal, ADA president of medicine and science, executive director of the International Diabetes Center (IDC) in Minneapolis, and professor at the University of Minnesota, focused on the patient-centered care model.

Bergenstal discussed how the IDC has successfully used patient-centered team care for the past 27 years. This model involves focusing on the patient as the most crucial member of the diabetes management team, which includes clinicians, diabetes educators, nurses, dietitians, and social workers providing staged diabetes management using ADA-developed standards of care.

Bergenstal noted how the best outcomes for patients with diabetes are consistently found in clinical research trials because patients enrolled in the trials have easy access to comprehensive care, reduced-cost or free medications, team support, and patient-centered care that emphasizes patient accountability for self-management. In addition, he stressed the importance of multicenter pilot studies and projects providing patient-centered diabetes care and encouraged the audience to get involved in advocacy efforts in support of diabetes team care and increased research funding.

HEALTHY Study: Middle School-Based Intervention to Reduce Diabetes Risk
Presenters discussed the findings of the HEALTHY Study, which were published in The New England Journal of Medicine. This study was a National Institutes of Health-sponsored, school-based, healthful-living intervention conducted in 42 schools with more than 4,500 students. For schools to be eligible, at least 50% of the children had to be black or Hispanic or at least 50% had to be eligible for free or reduced-price lunch. The primary outcome was a decrease in the combined prevalence of overweight and obesity.

The intervention consisted of four components: nutrition, physical activity, behavioral knowledge, and communications. Nutrition targeted school food quality. The physical activity component focused on increased time allocated to physical education. The behavioral knowledge component consisted of teaching self-awareness and behavioral skills such as goal setting. The final component—communications—used newsletters to maintain kids’ interest in the program.

At the beginning of sixth grade and at the end of eighth grade, researchers calculated students’ body mass index (BMI), waist circumference, fasting glucose, and insulin level. By the end of the study, there was a nearly significant reduction in the prevalence of obesity in the intervention schools. These children had a 19% lower risk of being obese at the end of the study than did those in the control group. (The P value was equal to 0.05, while a Pvalue of less than 0.05 is required to reach significance.)

Also, those in the intervention group had significantly greater reductions in BMI z scores and percentage of students with waist circumference at or above the 90th percentile (P = 0.04). There was no difference in mean plasma glucose levels or in the percentage of students who had glucose levels of 100 mg/dL or higher by the end of the study. Both groups experienced increases in fasting insulin levels between the beginning of sixth grade and the end of eighth grade, but those in the intervention group had significantly lower mean insulin levels than did students in the control schools (P = 0.04).

While the HEALTHY Study missed its primary end point of reducing combined rates of overweight and obesity compared with control schools, the intervention significantly reduced other measures of adiposity compared with controls, according to Gary D. Foster, PhD, of Temple University, and colleagues.

Controversies Relating Cancer With Diabetes, Obesity, and Insulin
Experts presented data in an attempt to clarify a subject fraught with controversy stemming from a 2009 article by Hemkens et al published in Diabetologia. The German study investigated the risk of malignant neoplasms and mortality in patients with diabetes treated with either human insulin or one of three insulin analogs.

Jeffrey Johnson, PhD, a professor at the University of Alberta in Edmonton, began the session by noting the strong epidemiological support of increased cancer and mortality risk in patients with diabetes. Some mechanisms of increased risk include obesity and health behaviors, hyperinsulinemia, and poor compliance with cancer screenings.

Several researchers spoke about the intricacies and complicated factors that must be taken into account when analyzing research in this area. Jay S. Skyler, MD, a professor at the University of Miami, concluded that the headlines appearing in the mainstream press suggesting glargine insulin causes cancer are “unsubstantiated, unwarranted, and unproven.”

Preventing Type 2 Diabetes
Frank B. Hu, MD, PhD, a professor at both the Harvard Medical School and the School of Public Health, delivered the annual Kelly West lecture. He stated that diet and lifestyle modifications can prevent most cases of type 2 diabetes, but that making modifications is difficult and requires changes both in individual behavior and in dietary and social environments.

Hu discussed a study that he and his colleagues conducted showing that overweight or obesity was the single most important predictor of the development of diabetes among a group of low-risk women. The study results also showed that lack of exercise, a poor diet, and cigarette smoking were associated with a significantly increased risk of diabetes. They found that sedentary behavior, especially TV watching, was associated with a significant risk of developing type 2 diabetes.

In the Chinese Da Qing study, there was still a 40% reduction in diabetes risk in the intervention group at 20 years’ follow-up—40 years after the intervention had ended. Almost everyone in the control group had converted from impaired glucose tolerance to diabetes at the end of the follow-up period, demonstrating the severity of inaction.

Additionally, Hu described a study of white rice consumption and the risk of diabetes among women in Shanghai. In this study, researchers found that substituting 50 g of brown rice for white rice each day reduced the risk of diabetes by 16% because brown rice is minimally processed and induces lower insulin responses.

Other studies have shown that interactions between certain genetic variants increase the risk of diabetes associated with dietary carbohydrates and sedentary behavior. Hu concluded that data from both observational and interventional studies provide evidence that lifestyle factors can actually counteract or even abolish the genetic risk associated with many of the variants that have been associated with obesity and type 2 diabetes.

— Janice H. Dada, MPH, RD, CSSD, CDE, CHES, is a dietitian, college nutrition instructor, and freelance writer based in southern California. Her areas of expertise include diabetes, weight management, wellness, and sports nutrition.