touchENDOCRINOLOGY was delighted to speak with Editorial Board member Dr Deep Dutta, a senior endocrinologist at the CEDAR Superspecialty Clinics, New Delhi, India. Throughout this interview, he summarizes the key messages from his late-breaking abstract session ‘Ailing Heart, Broken Vessels’, presented at the 60th European Association for the Study of Diabetes (EASD) annual meeting in Madrid, Spain. The session focused on recent research in the field of vascular endocrinology, with 5 oral papers being presented; 2 from India and 1 each from Spain, Germany and Japan.1–5 Of the 2 papers from India, his presentation was a combined work of authors from India and Bangladesh.
How does diabetes significantly impact the vascular system?
Diabetes is a chronic systemic inflammatory disorder. Hyperglycaemia per se, and the associated altered adipo-cytokine profile, hypertension and dyslipidaemia can impact the vascular system across the entire human body. They result in increased endothelial dysfunction, decreased pliability of blood vessels, earlier onset and accelerated progression of atherosclerosis, and increased risks of pro-thrombotic events, along with structural changes in the microvasculature – a classic example being the effacement of the podocytes in diabetic kidney disease.
What were the key findings from the studies presented?
We presented our work on the ‘Efficacy and safety of early initiation of SGLT2i following acute myocardial infarction: a systematic review and meta-analysis’.2 Our analysis of data from 6 major randomized controlled trials, having a cumulative patient number of more than 7,400, showed that initiation of sodium-glucose co-transporter-2 inhibitors (SGLT2i) within 2 weeks of an event of acute myocardial infarction was associated with significantly reduced future hospital admission with heart failure, and significantly better ejection fraction on echocardiography, without any impact on all-cause mortality, cardiovascular mortality, stroke or non-fatal myocardial infarction.
Lia Nattero-Chávez from Madrid, Spain, presented her work on investigating the link between intermediate metabolism, sexual dimorphism and cardiac autonomic dysfunction in patients with type 1 diabetes (T1D).3 In a cohort of 323 people living with T1D, she noted that 28% patients were living with cardiac autonomic neuropathy (CAN). CAN in her study was assessed using Ewing’s test (response of heart rate variability to deep breathing [E/I Ratio], standing [30:15 ratio], Valsalva manoeuvre and the response of blood pressure to active standing). Serum metabolites were assessed using proton nuclear magnetic resonance spectroscopy. Serum metabolites like lactate were found to be increased, whereas amino acids like isoleucine, threonine and valine were found to be significantly lower in people living with T1D and CAN. Authors concluded that metabolomic profile in people with T1D is associated with CAN.
Alba Sulaj from Heidelberg University, Germany, presented her work on comprehensive metabolic profiling during periodic fasting in individuals with type 2 diabetes mellitus (T2DM) and diabetic nephropathy.4 The reason for doing this work was that people with T2DM and nephropathy often have an heterogenous metabolic response to fasting. In her study, patients with T2DM with established diabetic nephropathy were randomized into 2 groups, the first group received fasting mimicking diet (n=20) and the other group received standard mediterranean diet (n=18). Blood metabolites were assessed using liquid chromatography with tandem mass spectrometry (LC-MS/MS) at baseline, at 3 months and at 6-month follow-up. Patients who had improvement in albuminuria at the end of the study were called responders, and the patients who did not have improvement in albuminuria were called non-responders. The authors noted that the responders had better low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) clearance, improved phospholipid metabolism along with reduced triglyceride synthesis.
Subhodip Pramanik presented on the association between vitamin B12 deficiency and reduced visual contrast sensitivity function in T2DM. In a cohort of 226 patients with T2DM with mild non-proliferative diabetic retinopathy, authors looked for serologic evidence of vitamin B12 deficiency. People diagnosed to have vitamin B12 deficiency (58%) received vitamin-B12 supplementation 1,000 mcg/day for 6 months, and then were re-assessed for the severity of retinopathy. People with vitamin B12 deficiency had reduced visual contrast sensitivity score at baseline, when compared with people who were vitamin B12 sufficient. Following 6 months of therapy, an improvement in the visual contrast sensitivity score was noted only in people with vitamin B12 deficiency.
Masami-Chin Kusunoki from Japan presented on the relationships between atherosclerotic parameters and aging, and effects of exercise on branchial-ankle pulse wave velocity in Japanese patients with type 2 diabetes.5 Exercise was noted to have a beneficial impact in reducing endothelial dysfunction as assessed using branchial-ankle pulse wave velocity, highlighting the importance of exercise in diabetes across all age groups, irrespective of the duration of diabetes.
How might these results influence future clinical practice?
There were many important messages from this session. We should be more guarded and conservative regarding the use of SGLT2i in acute myocardial infarction. Cardiac autonomic neuropathy assessment should be carried out in a specialized diabetes clinic to reduce morbidity in patients. Fasting, dieting and using a Mediterranean diet can have beneficial impact across the spectrum of diabetic nephropathy. Correcting vitamin B12 deficiency in diabetes would not only help in improving peripheral neuropathy, but also would help with vision. Exercise should be recommended in all people living with diabetes, irrespective of age and disease duration, to improve their endothelial dysfunction.
References
- Sinha AK, Prakash J. Prospective cohort study on the impact of intensive blood pressure control on macrovascular complications in type 2 diabetes individuals. Available at: https://cattendee.abstractsonline.com/meeting/20620/presentation/2923 (date last accessed: 19 September 2024)
- Dutta D, Nagendra L, Kamrul Hasan A, Mahajan K. Efficacy and safety of early initiation of sodium glucose co-transporter-2 inhibitors following acute myocardial infarction: a systematic review and meta-analysis. Available at: https://cattendee.abstractsonline.com/meeting/20620/presentation/2910 (date last accessed: 19 September 2024)
- Nattero-Chávez L, Insenser M, Luque-Ramirez M, et al. Investigating the link between intermediate metabolism, sexual dimorphism, and cardiac autonomic dysfunction in patients with type 1 diabetes. Available at: https://cattendee.abstractsonline.com/meeting/20620/presentation/2940 (date last accessed: 19 September 2024)
- Sulaj A, Nguyen PBH, Poschet G, et al. Comprehensive metabolic profiling during periodic fasting in individuals with type 2 diabetes and diabetic nephropathy. Available at: https://cattendee.abstractsonline.com/meeting/20620/presentation/2909 (date last accessed: 19 September 2024)
- Kusunoki M, Hisano F, Abe T, et al. Relationships between atherosclerotic parameters and aging, and effects of exercise on branchial-ankle pulse wave velocity in Japanese patients with type 2 diabetes. Available at: https://cattendee.abstractsonline.com/meeting/20620/presentation/2912 (date last accessed: 19 September 2024)
Support: No funding was received in the publication of this short article.
Cite: Dutta, D. EASD 2024: The latest in vascular endocrinology – insights from the late-breaking session ‘Ailing Heart, Broken Vessels’. touchENDOCRINOLOGY. October 2, 2024.
