Early diagnosis, treatment intensification essential to improve diabetes outcomes
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Key takeaways:
- Early diagnosis and treatment of diabetes can add years to a person’s lifespan.
- Glucose-lowering therapies should be individualized using a holistic, person-centered approach.
BOSTON — Interventions that prevent or delay the onset of type 2 diabetes are critically important, and early diagnosis and treatment intensification can improve outcomes and increase lifespan, according to a speaker.
Despite the development of several new classes of diabetes medications and devices and advances in understanding of the importance of glucose control, only about half of people with type 2 diabetes are achieving a target HbA1c of less than 7%, Juan P. Frias, MD, medical director and principal investigator at Velocity Clinical Research in Los Angeles, said during a presentation at the Cardiometabolic Health Congress.
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More alarming, Frias said, is that about a quarter of people with type 2 diabetes are not diagnosed, which means they are not being treated.
Frias said that, irrespective of any other potential risk factors, anyone aged 35 years or older should be tested to see if they have prediabetes or overt type 2 diabetes; if a patient has normoglycemia, they should be retested at least every 3 years.
“The reason this becomes important is because we want to treat and treat early,” Frias said.
Long-term disease, shortened lifespan
Data from the Emerging Risk Factors Collaboration, published in September in The Lancet Diabetes & Endocrinology, showed that loss of life is considerably greater among people who are diagnosed with type 2 diabetes at a younger age than in those who are diagnosed when older. In the analysis, which pooled data from cohorts in high-income countries, researchers reported that every decade of earlier diagnosis of diabetes was associated with about 3 to 4 years of lower life expectancy, Frias said.
“This drives home that we need to make sure patients can be diagnosed and can be treated aggressively and treated early,” Frias said. “Secondly, when patients are diagnosed, we need to be aggressive about treating not only their glucose, but their CV risk factors.”
Data from the U.K. Prospective Diabetes (UKPDS) study, which first began in 1977 with patients with new-onset diabetes treated either aggressively or with diet plus lifestyle, show the impact of the “legacy effect” of intensive glucose management after the randomized part of the study ended, Frias said. New follow-up observational data published in 2022 show that the benefits of good glucose management persist 44 years later, with 11% fewer deaths and 26% fewer complications among patients who received insulin or sulfonylurea therapy. The metformin group also had fewer deaths and MIs compared with the lifestyle arm.
“Despite the convergence of HbA1cs [across study arms], you continue to see not only a continued reduction in the relative risk for any diabetes-related endpoint, but also MI and all-cause mortality,” Frias said.
“We need to be very aggressive”
Today, there are far more options for people with type 2 diabetes beyond metformin and sulfonylureas, Frias said, with data showing effects beyond glucose for SGLT2 inhibitors and GLP-1 receptor agonists. Frias said it is important to individualize therapy for patients, using a holistic, person-centered approach. That means considering a person’s need for cardiorenal protection, weight management and management of CV risk factors.
“We need to not take our eye off glycemic control, and especially early glycemic control,” Frias said. “We need to diagnose our patients earlier and make sure that the 23% of patients that have diabetes who are not diagnosed ... are identified. We need to be very aggressive in managing not only CV risk factors but also glycemia in these patients. We need to follow patients, because many will have a continued decline in beta-cell function and will need additional therapies.”
Reference:
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Frias JP. Early treatment intensification in type 2 diabetes. Presented at: Cardiometabolic Health Congress; Oct. 18-21, 2023; Boston.
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