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AACE, ADA/EASD deliver perspective on glucose-lowering drugs at ACC
SAN FRANCISCO — Clinicians on behalf of the American Association of Clinical Endocrinologists and the American Diabetes Association/European Association for the Study of Diabetes have agreed that individualization is key for the management of diabetes. However, potential treatments and targets have been a point of debate.
During a symposium session at the American College of Cardiology Scientific Sessions, Yehuda Handelsman MD, FACP, FACE, FNLA, and Anne L. Peters, MD, FACP, provided their perspective on the similarities and differences between guidelines. In recent years, guidelines and position statements from the two organizations have varied, leading to further questions regarding treatment approaches.
Yehuda Handelsman
The AACE perspective
“I was charged to try and look at glucose-lowering drugs and how we manage patients with diabetes. We endocrinologists have perhaps a wider look at the patient and don’t see only heart disease, even though we very much focus on heart disease,” Handelsman, medical director and principal investigator of the Metabolic Institute of America in Tarzana, Calif., said during a presentation. “However, we do see blindness, amputations, kidney failures and dialysis. And our task is to manage our patients to prevent all of these complications.”
Handelsman presented the latest position statement on the management of hyperglycemia in patients with type 2 diabetes on behalf of AACE, compared with ADA/EASD.
Handelsman critiqued the algorithms provided by ADA/EASD in recent years.
“Diabetes is not simple. It’s polygenic, if you will. There are many aspects of diabetes. When there is hyperglycemia, it begets hyperglycemia, leading to glucose toxicity. We like combined drugs that target different metabolic effects,” Handelsman said.
The older ADA/EASD algorithm promoted hypoglycemia the AACE algorithm focuses on safety — preventing hypoglycemia and weight gain.
He added that glycemic control is not the only way to manage diabetes.
“We have to allow the physician to personalize the management for the patient,” Handelsman said. “It’s important to recognize individualized goals with personalized therapy and that lifestyle and metformin should be key.”
In 2011, AACE published comprehensive guidelines on diabetes management, taking a comparative approach to examine obesity, hypertension, lipids, coagulation and LDL goals among patients with diabetes, he said.
According to Handelsman, the organization will release a new consensus algorithm on the comprehensive management of diabetes this year.
ADA/EASD perspective
“I’m not going to argue that one set of guidelines are better than another but just that there are different guidelines, and I think that really speaks to the fact that we have so many different medications, so many different patients and so many different approaches that work in different settings,” Peters, director of the USC Clinical Diabetes Program and professor at the Keck School of Medicine in Los Angeles, said during a presentation following Handelsman.
Peters said the reasoning behind creating new guidelines in June 2012 was due to an increasing number and variety of hypoglycemic medications, new data, increasing concerns about drug safety and discourse about personalized and patient-centered care.
“When I treat patients with diabetes, I believe I am reducing their risk for microvascular complications. And to many of my patients, that’s very important. Those are complications our patients don’t want to develop. I also know I can reduce cardiovascular mortality with statins, BP medication and aspirins,” she said.
Peters highlighted the ADA/EASD position statement on the management of hyperglycemia in patients with type 2 diabetes following Handeslman.
“Each drug class has a unique mechanism of action, each drug class lowers blood glucose to about the same extent, many have additional benefits, but the effect of those over the long-term are unknown. Indeed, the comparative effects of most agents on long-term outcomes are not known. There are major differences in side effects and cost,” Peters said.
Peters concluded by reporting that the ADA/EASD felt that given the diversity of patients and clinical settings, proscriptive algorithms were not possible. However, within a practice setting it is possible, she said.
“The overarching concern is to provide safe and effective glucose-lowering medications over many years to reduce the complications of diabetes,” Peters said. – by Samantha Costa
For more information:
Joint symposium of the American Association of Clinical Endocrinologists and the American College of Cardiology: The Endocrine Heart. Presented at: American College of Cardiology Scientific Sessions; March 9-11, 2013; San Francisco.
Disclosure: Handelsman reports financial ties with DSI, Santarus, Amylin, Novo Nordisk, BI-Lilly, Merck, Sanofi, and GlaxoSmithKline. Peters reports financial ties with Lilly, Sanofi, Abbott, Johnson & Johnson, Roche, Takeda, Amylin and Novo Nordisk.