DOC News February 1, 2007
Volume 4 Number 2 p. 9
© 2007 American Diabetes Association
Impressions From the IDF in South Africa
Irl B. Hirsch, MD
The International Diabetes Federation (IDF) World Diabetes Congress (WDC)
is held every 3 years. In December, the 19th WDC met in Cape Town, South
Africa. This was one of the major international diabetes conferences of 2006
and will be remembered for several notable presentations.
First, A Diabetes Outcome Progression Trial (ADOPT) was presented and
published
simultaneously.1 In
this trial assessing long-term efficacy of rosiglitazone compared with
metformin or glyburide, the thiazolidinedione seemed to win the battle but
perhaps not the overall war on
diabetes.2
Second, in September 2006, the DREAM (Diabetes Reduction Assessment with
Ramipril and Rosiglitazone Medication) results were
published.3 In this
trial, rosiglitazone at 8 mg daily for 3 years substantially reduces incidence
of type 2 diabetes and increases the likelihood of regression to normoglycemia
in adults with impaired fasting glucose, impaired glucose tolerance, or both.
Follow-up of a 71-day washout period was reported at the IDF meeting. Formal
oral glucose tolerance testing was administered to more than 3,200
participants. In the rosiglitazone and placebo groups, 10.6% and 9.7%
developed diabetes, respectively, suggesting that rosiglitazone only works in
preventing type 2 diabetes while the medication is taken. No cases of heart
failure occurred in the washout, lipid levels were not reported, and weight
was not measured.
Last, Sanofi-Aventis's SERENADE (Study Evaluating Rimonabant Efficacy in
Drug-Naive Diabetic Patients) compared rimonabant to placebo in obese subjects
with type 2 diabetes. In this 56-center trial with 278 patients, 20 mg of
rimonabant was compared with placebo, with a baseline glycated hemoglobin
(A1C) of 7.9%. Julio Rosenstock, MD, reported that patients in the rimonabant
arm had a 0.8% reduction in A1C compared with a 0.3% decrease with placebo
(P = 0.002). Those on active drug also lost an average 6.7 kg (14.7
lb) compared with an average 2.7 kg (5.9 lb) for placebo-treated patients
during this 6-month trial. Not surprisingly, those receiving rimonabant also
had improved HDL cholesterol and triglyceride levels. The most common side
effects with rimonabant were dizziness (10.9%), nausea (8.7%), nasopharyngitis
(7.2%), upper respiratory tract infection (7.2%), anxiety (5.8%), depressed
mood (5.8%), and headache (3.6%).
The IDF World Diabetes Congress is vastly different from an American
Diabetes Association meeting or the annual meeting of the American College of
Physicians. The exhibit booths are smaller, and fewer pharmaceutical
representatives attend. There is generally little interest in medical devices,
particularly pumps and glucose sensors, for the simple reason that many
countries are not able to afford this technology.
Indeed, the main theme for many participants is the ability to provide
enough insulin to people with type 1 diabetes, to say nothing of patients with
type 2 diabetes. Insulin analogs are still novel to many countries.
Yet diabetes is quickly becoming the most important international epidemic
of this century. How each country and society will be able to treat this
disease, let alone prevent it, may become one of the most interesting stories
of the future. 
References
1. Kahn SE, Haffer SM, Heise MA, et al.: Glycemic durability of
rosiglitazone, metformin, or glyburide monotherapy. N Engl J
Med 355:2427–2443, 2006.[Abstract/Free Full Text]2. Nathan DM: Thiazolidinediones for the treatment of type 2 diabetes?
N Engl J Med 355:2477–2480, 2006.[Free Full Text]
3. The DREAM (Diabetes REduction Assessment with ramipril and
rosiglitazone Medication) Trial Investigators: Effect of rosiglitazone on the
frequency of diabetes in patients with impaired fasting glucose or impaired
glucose tolerance: A randomised controlled trial.
Lancet 368:1096–1105, 2006.[Medline]
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