Get the latest updates from Day 2 of the American Diabetes Association's (ADA) 82nd Scientific Sessions.
Updates from Day 2 of the ADA 82nd Scientific Sessions
Catch up on some of the latest updates to come from Day 2 of the American Diabetes Association’s 82nd Scientific Sessions.
Reaching Everyone—Health Disparities and Sex Differences in Physical Activity
Physical activity can have downstream effects on our patients’ health, but can disparities in access hurt our patients? That is what Dr. Carlos Crespo from the OHSU-PSU School of Public Health aimed to find out.
Dr. Crespo began by taking a look at the four domains of physical activity: occupation physical activity, transportation physical activity, leisure-time physical activity, and incidental physical activity. According to the National Health and Nutritional Examination Survey, from 2007 to 2018, the prevalence of physical activity hadn’t changed much, but over the period of COVID-19, has gotten worse.
According to Dr. Crespo, this has a lot to do with barriers to leisure-time physical activity and transportation physical activity, including lack of time; safety concerns; high costs; lack of footpaths, cycle lanes, parks; and more. Barriers to physical activity were found to be disproportionately higher for women and in rural areas.
But there are several ways we can improve access by combining park, trail, or greenway infrastructure improvements with other interventions, such as community engagement, public awareness activities, structured opportunities for physical activity and social interaction, and access enhancements such as transport connections, street crossings, and expanded hours of operation.
Walkability Matters: Keeping It in The Neighborhood To Prevent And Manage Diabetes
Following Dr. Crespo, Dr. Natalie Colabianchi from the University of Michigan explored the impacts of walkability on preventing and managing diabetes.
She began by defining walkability as the degree to which an area is conducive to and supportive of walking including destinations, land use mix, population density, street connectedness, and aesthetics. To measure walkability and its impact, Dr. Colabianchi reviewed the REGARDS study, which was a national sample of 30,239 Black and white Americans, and found the following:
- Living in very walkable or walkers paradise areas with associated with a 25 to 45% decrease in risk of overweight or obesity in association with waist circumference were from very walkable only about 30% at lower risk
- Living in somewhat walkable areas was associated with a 34% decrease in the risk of incident diabetes
What can we conclude from this? According to Dr. Colabianchi, walkability and physical activity have proven to reduce the risk of not only diabetes, but also obesity, and they could have strong downstream effects on the population.
Biological Sex and Ethnicity – Impact on Physical Training and Activity Assessment
To conclude the session, Dr. Siana Jones from the University College London took a look at the impact of biological sex and ethnicity on physical training and activity assessment to permit the design of more specific and effective interventions that could mitigate health inequalities.
In a study evaluating young children 1 to 4 years old, researchers found that girls had lower active playtime and Black-American children had lower active play time than White-American children, leading Dr. Colabianchi to conclude that many of these biological sex and ethnicity discrepancies are indicative of limited access to physical activity. And while biology may play a role, access plays a much more significant role in determining how physically active a patient will be.
Access to physical activity can greatly improve health outcomes and removing barriers to access can help women and minority patients prevent obesity, diabetes, and other risks. It’s important that we continue to find ways to strengthen access to all communities.
Weighing the Evidence: Should Obesity be the Primary Target of Treatment in Type 2 Diabetes
As the diabetes treatment landscape continues to evolve, it’s important for healthcare professionals to fully understand the primary target of these therapies and establish clear, measurable goals for their patients. However, the complexity of the disease leaves room for debate regarding what, exactly, should be the focus of treatment: Weight loss or glucose control.
At the day 2 session “Weighing the Evidence: Should Obesity be the Primary Target of Treatment in Type 2 Diabetes,” Dr. Deborah Wexler of Massachusetts General Hospital invited Drs. Ildiko Lingvay and Jeffrey Mechanick debate the benefits of weight control vs. glucose control for treatment.
Weight Loss Should be the Primary Target for the Treatment of T2D
Dr. Ildiko Lingvay of the University of Texas Southwestern Medical Center was the first to present and argued that weight loss should be the primary target for T2D treatment.
Dr. Lingvay presented several studies that clearly illustrated the benefits of weight loss for diabetic patients. In the Diabetes Prevention Program (DPP) Experience study, every kilogram a patient lost reduced the risk of diabetes by 16%. However, a major challenge for any weight loss treatment is keeping the weight off over time.
That lead Dr. Lingvay to explain the benefits of bariatric surgery for T2D patients. While bariatric surgery, according to Dr. Lingvay, is not a common treatment for weight loss related to diabetes treatment, it is an effective one and should be explored as an option by more healthcare professionals. According to the STAMPEDE study, gastric bypass or sleeve gastrectomy generated greater weight loss and more significant decreases in HbA1c levels for T2D patients than medical therapy.
The amount of weight a patient needs to lose to attain positive results for diabetes treatment is between 10-20%. Dr. Lingvay recommends that a “sweet spot” of 15% weight loss is the new 7% A1C in terms of diabetic treatment goals.
Dr. Lingvay said the means of weight loss in diabetic patients is less important if weight loss is sustained. While bariatric surgery shows positive weight loss results, new drugs are being studied and will provide more treatment options. In a recent study, 45% of patients taking semaglutide 2.4 mg achieved 10% weight loss or more. And tirzepatide has proven to sustain weight loss during a 40-week treatment.
Dr. Lingvay concluded her argument by recommending the ADA adopt a new treatment algorithm that focuses more on weight loss.
Glucose Control Should be the Primary Target of Treatment in T2D
Dr. Jeffrey Mechanick, professor of medicine at Mount Sinai School of Medicine, took to the stage to provide the counterargument: Glucose control is more important than weight loss for T2D treatment. Dr. Mechanick was quick to point out he does not disagree with Dr. Lingvay but instead took the opportunity to better define the arguments and establish clear language that can be used by medical professionals.
Instead of arguing if one target was more important than another, Dr. Mechanik outlined how diabetes treatments are not mutually exclusive. Weight loss and glucose control exist as therapy targets concurrently, but patient context matters.
Dr. Mechanick said there are multiple primary targets for the treatment of T2D, such as adiposity, dysglycemia, and cardiometabolic risk factors. These can be prioritized based on:
- Relative risk
- Logistical ease
- Cost
- Individual factors
Throughout the debate, Dr. Mechanik explained the importance of tailoring the therapy to the patient. He recommended adjusting treatment based on ethnicity, providing the example that treatment guidelines based on a study in which test subjects were primarily white may not be as useful for a patient of Asian ethnicity.
Dr. Mechanick believes treatment should be tailored to the patient according to:
- Stage of the disease
- Metabolic driver
- Social determinants
- Other clinical priorities
He also said early intervention is crucial. HCPs should not wait for the disease to progress. Dr. Mechanick made it clear that his stance was not that glucose control should be the sole, primary target for treatment, but weight loss and glucose control are part of the same conversation.
The Importance of Both Weight Loss & Glucose Control
Weight loss and glucose controls are clear primary targets for diabetes treatment. It is important for HCPs to understand these targets and the risks and benefits associated with focusing on only one area of treatment. While weight loss contributes to better holistic health, glucose control remains crucial for T2D treatments. This session helped highlight the need for strategic diabetes care.