The tutor taught!7 May 2010

Three tutors from the Primary Care Training Centre spent an excellent couple of days at the Holiday Inn Stratford-upon-Avon recently at a Diabetes Update Conference organised by Professor Neil Poulter and his colleagues. Professor Poulter always manages together an excellent group of experts who fire from the hip rather than clouding everything in a welter of incomprehensible statistics. Such people as Clifford Bailey, Bryan Williams, Ian Campbell and Graeme McGregor are always worth travelling to hear.

Throughout the two days, there was an increasing emphasis on declining beta cell function as an equal component of Type 2 diabetes with insulin resistance: particularly in a brilliant lecture by Professor Clifford Bailey. This also cast doubt on the future role of sulphonylureas. Stimulating cells which are failing may not be a good idea and there is a lack of evidence of the effectiveness of SU's as preventers on the long term complications of diabetes.

Weight is a major problem although there are a large number of women developing diabetes with only modest weight increase. Perhaps the keynote of the whole conference is that it is now possible to treat hyperglycæmia AND achieve weight loss using drugs working on the incretin system. In this respect there was a large pitch made for the use of a once-a-day injection of liraglutide with the prospect of once-weekly injections on the horizon. However, one has to keep at the back of one's mind that this session of the conference was sponsored by one of the two major conference sponsors, NovoNordisk.

The other major sponsor was Takeda UK with a consequent session which was essentially a whitewash of pioglitazone. This is understandable as the drug has been covered in some of the fallout from the rosiglitazone affair; particularly some especially silly remarks from diabetes experts who should know better and luckily did not figure at this particular conference.

Professor Bryan Williams was in sparkling form. His session on renal disease and a debate with Professor Graeme McGregor on the subject of "Does proteinuria matter?" were worth the admission price alone. The debate was a really good example of the academic mind at work. On looking at the title, a simple person like me would be tempted to say, "well yes, of course proteinuria matters. What's the discussion about?" But, in fact, the catch is that proteinuria is a marker for a whole host of other nasty things but is not harmful in itself! A subtle point but obvious when you think about it. Incidentally, Professor Williams emphasised that protein in the urine is just one small point in a large one and that protein leaks out of blood vessels everywhere when it is leaking into the glomerulus.

Another high point was Professor Clifford Bailey's explanation of the incretin effect and how it may not only enhance (not stimulate) insulin production but may also impact on the neural response to food intake.

A lot of high-powered stuff but brilliantly explained. This team do a similar conference on Hypertension which is highly recommended. Why cannot all conferences be like this?