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Highlights from the American Diabetes Association annual meeting for PCPs

Kim Pfotenhauer

A potential new treatment for type 1 diabetes, an analysis of cardiovascular outcome trials for patients with the condition and how to treat diabetes in youth, were some of the top takeaways from this year’s American Diabetes Association meeting, according to an interview with an ADA member.

Kim Pfotenhauer, DO, assistant professor of primary care at Touro University, California, discussed the meeting’s highlights with Healio Family Medicine.

Among the most significant presentations was data about a dual SGLT1 and SGLT2 inhibitor for treating type 1 diabetes, which Pfotenhauer described as “interesting.”

Researchers at the meeting presented data from a study of 793 adults randomly assigned 200 mg or 400 mg of Zynquista (sotagliflozin, Lexicon/Sanofi) or placebo daily for 1 year, starting 6 weeks after reaching insulin optimization.

Patients who took either dose of sotagliflozin had improved patient satisfaction scores and HbA1c levels at week 24, and lower HbA1c, bolus insulin, patient distress and weight at week 52. These patients also experienced more genital mycotic infections, diarrhea and diabetic ketoacidosis events, whereas the highest incident of severe hypoglycemia was among patients who received placebo.

“This would be the first new treatment for type 1 diabetes since insulin was introduced,” she said.

Abstracts using data from cardiovascular outcome trials “was another major focus” at the meeting, Pfotenhauer continued.

• CANVAS data showed that patients whose diabetes was not controlled by metformin had improved health outcomes at lower costs when they received Invokana (canagliflozin, Janssen) vs. Januvia (sitagliptin, Merck) as a second line therapy.
• ELIXA data indicated that patients with type 2 diabetes and a recent acute coronary event who received Adlyxin (lixisenatide, Sanofi) had a reduced urinary albumin-to-creatinine ratio among those who also had micro- or macro-albuminuria at baseline. These patients also had lower incidence of macroalbuminuria beyond glycemic control.
• EMPA-REG data revealed that patients with type 2 diabetes and established CVD who received either 10 mg or 25 mg of Jardiance (empagliflozin, Boehringer Ingelheim/Lilly) had reduced alanine aminotransferase and aspartate aminotransferase levels vs. patients who took placebo.
• EXSCEL data showed that patients with type 2 diabetes who received 2 mg Bydureon (exenatide, AstraZeneca) once weekly had significant reductions in outpatient visits to diabetes care providers and inpatient hospital days vs. patients who received usual care or placebo.
• LEADER data indicated that patients with type 2 diabetes and a significant risk for CVD who were treated with basal insulin and Victoza (liraglutide, Novo Nordisk) had improved glycemic control, reducing the risk for severe hypoglycemia by half, and lowered body weight vs. patients not treated with insulin.

• SUSTAIN data revealed that patients with type 2 diabetes who received Ozempic (semaglutide, Novo Nordisk) once weekly had significantly greater reductions in HbA1c levels, body weight and systolic BP vs. those who received Trulicity (dulaglutide, Eli Lilly), extended release exenatide, insulin glargine, placebo, or sitagliptin.

“Continuous glucose monitoring continued to be defined and refined at the meeting as well,” Pfotenhauer said. “These devices are being used in both type 1 and type 2 diabetes to get a more complete picture of the day to day variation of glucose, and I feel that it will become the standard of care in a very short time.

“Diabetes in youth was another main theme of the meeting,” she added. “This is an emerging field as the population of youth with type 2 diabetes grows and as primary care physicians, we are on the front lines.”

Data presented at the meeting involving this population group included:

About 25% of overweight and obese youth with one additional risk factor go on to develop diabetes. Currently, the ADA recommends screening for prediabetes or type 2 diabetes in overweight youth who have two additional risk factors.

Patients ranked the main barriers to treatment as difficulty following-through with lifestyle changes, lack of support to make lifestyle changes, lack of motivation to control diseases, socioeconomic challenges, and transportation difficulties.

Health care providers considered patient adherence and inability to focus on diabetes, hyperlipidemia and hypertension during short office visits as the barriers to patients receiving treatment.

The median adherence of patients to self-monitoring of blood glucose — metformin and rosiglitazone — was 49% at 6 months, then dropped to 41% at 1 year in those who had HbA1c levels of 8% or greater. Patients whose HbA1c levels were 8% or greater only 80% of the time had median self-monitoring of blood glucose levels of 25% at 6 months and fell to 19% at 1 year.

“The ADA also put forth a draft of new guidelines for the treatment of type 2 diabetes, which reinforced metformin and lifestyle as first-line treatments, but second line treatments should take into account cardiovascular disease, minimizing side effects such as hypoglycemia and addressing weight loss and cost,” Pfotenhauer said.

“These guidelines also recommended that GLP-1 receptor agonists should be the first choice, rather than basal insulin, when an injectable is needed for treatment intensification, “she said. “This recommendation will be a very welcome change for primary care physicians as these medications provide weight loss, glucose control and often cardiovascular benefits with very few side effects,” she added. – by Janel Miller

References:

Beaulieu LC, et al. Management of hypertension and hyperlipidemia in youth with T2D.

Buse JB, et al. Fifty-two-week efficacy and safety of sotagliflozin, a dual SGLT1 and SGLT2 Inhibitor, as adjunct therapy to insulin in adults with type 1 diabetes (in Tandem 1).

Dungan KM, et al. More subjects achieved composite reductions of 1% HbA1c, 5% Body weight, and 5 mmHg SBP with semaglutide vs. comparators (SUSTAIN 1-5, 7).

Reed SD, et al. EXSCEL — Once-weekly exenatide reduces medical resource utilization in patients with type 2 diabetes mellitus.

Saleh M, et al. Risk factors of youth type 2 diabetes (Y-T2DM) and prevalence of dysglycemia (DG).

Sattar N, et al. Improvements in liver enzymes with empagliflozin in the EMPA-REG OUTCOME trial.

Tack C, et al. Liraglutide effects in insulin-treated patients in LEADER.

Van Raalte DH, et al. Lixisenatide and renal outcomes in patients with type 2 diabetes — A post-hoc analysis of the ELIXA trial.

Weinstock RS, et al. Self-monitoring of blood glucose (SMBG) in youth with poorly controlled type 2 diabetes (T2D) in the TODAY study.

Willis M, et al. Assessing the value of canagliflozin (CANA) vs. sitagliptin (SITA) as second-line therapy in the U.S. — The importance of considering evidence from the CANVAS program.

All presented at: American Diabetes Association 78th Scientific Sessions. June 22-26, 2018; Orlando, Fla.

Disclosure: Pfotenhauer reports no relevant financial disclosures. Please see the abstracts for those authors’ relevant financial disclosures.