Spotlight interview with Chantal Mathieu

Chantal Mathieu is Professor of Internal Medicine and Chair of Endocrinology at the University Hospital Gasthuisberg, Catholic University of Leuven, Belgium. Prof. Mathieu received her medical degree and PhD at the University of Leuven, where she subsequently completed training in internal medicine and endocrinology. Prof. Mathieu’s clinical areas of interest include the organisation of diabetes care, and she is involved in several clinical trials in type 1 and type 2 diabetes. Her basic research is focused on the prevention of type 1 diabetes, effects of vitamin D on the immune system and diabetes, and functioning of the insulin-producing beta cell. Prof. Mathieu has authored or co-authored more than 350 peer-reviewed publications in international journals. In 2013, Prof. Mathieu received the prestigious InBev-Baillet Latour Prize for Clinical Research for her pioneering research on the pathogenesis of type 1 diabetes. She presently coordinates the INNODIA project on prevention and intervention in type 1 diabetes in Europe and is Senior Vice-President of the European Association for the Study of Diabetes (EASD) and Chair of Postgraduate Education at EASD.

What are your highlights of 2019?

I was thrilled by the growing evidence we have on new glucose lowering therapies that do so much more than just lower glucose. We have now growing evidence for GLP1 receptor agonists, that they impact on MACE occurrence in individuals with T2D, not only in the presence of pre-existing ASCVD, but also in the presence of a high risk of ASCVD (like age, like left ventricular hypertrophy or presence of stenosis of large vessels). This was specifically demonstrated now for Trulicity in the REWIND study (confirming indications in other studies like LEADER). The growing evidence of the renoprotective effects of SGLT2 inhibitors and of course the dramatic results of the Dapa-HF study, demonstrating that the effect of SGLT2 inhibitors (specifically dapagliflozin in this study) on mortality and hospitalisation for heart failure in people with pre-existing HFrEF not only happens in people with T2D, but also in people without T2D.  These clinical trials have lead the ADA/EASD to revise their consensus on glucose lowering therapies in T2D diabetes, giving these two classes of drugs even more prominent places, suggesting addition of SGLT2i or GLP1 RA to lifestyle modifications and metformin independent of baseline HbA1c or target HbA1c.

What have been the major breakthroughs and data?

Besides the studies described above, I was also struck by the VERIFY study, where investigators demonstrated that early combination therapy (with metformin and vildagliptin, a DPP4 inhibitor), alters the course of T2D. Indeed, in this study, it was shown that combination therapy delays the need for additional glucose lowering therapies compared to metformin alone, but with impact even when people receive sequential metformin and vildagliptin. Early combination is not only better than metformin only, but also than sequential metformin and vildagliptin. This intriguing observation suggests again that early therapy is crucial in T2D.

Of course, the evolutions in T1D are also very exciting. The evidence that novel therapies (sensors, pumps) really alter the lives of people with T1D, but in particular the exciting data on a more than 2-year delay in progression from high risk (multiple antibodies) to over T1D by a short course of Tepluzimab (anti-CD3 antibodies). This observation is a solid building block to shape our new intervention studies aiming at arresting and finally curing T1D and give hope to families.

What are the current hottest topics, and what do you hope to see in 2020?

I hope to see more studies on interventions targeting T1D arrest and in particular I look forward to studies coming from the EU network I coordinate: INNODIA. There we will report groundbreaking data on novel ways to define risk for T1D and describe novel biomarkers. More can be read on www.innodia.eu

Support: No funding was received in the publication of this Insight article.

Published: 2 January 2020