In The News

Coprogression of Cardiovascular Risk Factors in Type 1 Diabetes During 30 Years of Follow-up in the DCCT/EDIC Study

July 2016. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study demonstrated the beneficial effect of intensive therapy on cardiovascular outcomes, while identifying hyperglycemia as a dominant risk factor for patients with type 1 diabetes (T1D). This analysis evaluated the extent to which glycemic exposure influenced long-term changes in established risk factors for cardiovascular disease (CVD) among patients with T1D. Of the surviving DCCT cohort, 96% were enrolled for an additional 20-year observational study.

FDA Approves a Dedicated Syringe to Be Used With Humulin R U-500 Insulin

July 8, 2016. The US Food and Drug Administration (FDA) has approved a dedicated syringe for the administration of Humulin R U-500 insulin. This is now the only device approved for use with the U-500 insulin vial. Since conversions are no longer needed with this new device, the Humulin R U-500 insulin vial label will be updated to remove the dose conversion information for U-100 and tuberculin syringes. Approved syringes for use with Humulin R U-500 insulin vials will only be available with a prescription and should be co-prescribed with U-500 insulin.

Do Patient Characteristics Impact Decisions by Clinicians on Hemoglobin A1C Targets?

June 20, 2016. This retrospective study was conducted to determine whether physicians consider individualized risks and the benefits of tight glycemic control when setting A1C targets. Investigators evaluated National Health and Nutrition Examination Survey (NHANES) data for individuals with self-reported diabetes over an 8-year period between 2005 and 2014.

Efficacy and Safety of Switching From Sitagliptin to Liraglutide in Patients With Type 2 Diabetes (LIRA-SWITCH)

July 2016. This randomized, double-blind, double-dummy, active-controlled 26-week trial was conducted at 86 sites worldwide to confirm the superiority of switching from sitagliptin to liraglutide on glycemic control. Participating patients (N=407) had type 2 diabetes (T2D) managed with metformin and sitagliptin. The primary endpoint was changes in A1C levels, with a secondary endpoint of change in body weight.

Cardiovascular Safety of Empagliflozin In Patients With Type 2 Diabetes: A Meta-analysis

July 2016. This meta-analysis of data from 8 randomized placebo-controlled trials was conducted to evaluate the efficacy and safety of empagliflozin 10 mg and 25 mg once daily in patients with type 2 diabetes and at low/medium and high cardiovascular (CV) risk. The primary endpoint was a 4-point major adverse CV events (MACE) composite of CV death, non-fatal myocardial infarction (MI), non-fatal stroke, and hospitalization for unstable angina. The secondary endpoint was a 3-point MACE composite of CV death, non-fatal MI, and non-fatal stroke.

Persistent Effects of Intensive Glycemic Control on Retinopathy in Type 2 Diabetes in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Follow-On Study

July 2016. This study evaluated whether the beneficial effects of intensive glycemic control and fenofibrate treatment to reduce retinopathy progression in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study persisted in the 4 years beyond the initial study period. Progression was defined as ≥3 steps in the Early Treatment Diabetic Retinopathy Study Scale. At follow-up, all patients had similar A1C levels.

Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes

June 14, 2016. This study evaluated a prespecified secondary objective of the EMPA-REG OUTCOME study: long-term renal outcomes associated with the use of the sodium-glucose cotransporter-2 inhibitor empagliflozin in patients with type 2 diabetes at high risk for cardiovascular events. Patients were randomly assigned to receive empagliflozin 10 or 25 mg or placebo. Incident or worsening nephropathy and rates of renal replacement therapy were all significantly lower in the empagliflozin group.

FDA Releases a Drug Safety Communication With Strengthened Kidney Warnings for Canagliflozin and Dapagliflozin

June 14, 2016. The US Food and Drug Administration has strengthened an existing warning regarding the risk of acute kidney injury with use of the sodium-glucose cotransporter-2 inhibitor medicines canagliflozin and dapagliflozin for the treatment of type 2 diabetes. Specifically, the FDA has revised the warning section of the canagliflozin and dapagliflozin drug labels to include information about acute kidney injury and recommendations to minimize this risk.

Cardiovascular Mortality in Patients With Type 2 Diabetes and Recent Acute Coronary Syndrome

This study—Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care (EXAMINE)—evaluated the risk of cardiovascular (CV) death in all EXAMINE study participants compared with patients who experienced a major, nonfatal CV event during the EXAMINE study period. Patients with type 2 diabetes (N=5,380) who had experienced an acute coronary syndrome within the past 15 to 90 days were assigned to treatment with alogliptin or placebo. Outcomes evaluated included CV death and other nonfatal CV events.

The LEADER Study: Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes

This randomized, double-blind trial evaluated the cardiovascular (CV) effects of liraglutide versus placebo in patients with type 2 diabetes and high cardiovascular rish. The composite primary outcome of this time-to-event noninferiority trial included the first occurrence of death from CV causes, nonfatal myocardial infarction, or nonfatal stroke. A total of 9,340 patients were followed for a median of 3.8 years.

Once-Daily Delayed-Release Metformin Lowers Plasma Glucose and Has Similar Effect on Gut Hormones Compared With Immediate-Release Metformin

Two small, randomized controlled, crossover trials (one blinded, one not) were conducted to evaluate the gut-based action of a delayed-release (DR) formulation of metformin vs immediate-release (IR) metformin. Patients receiving metformin DR had an almost 60% reduction in systemic drug exposure compared with metformin IR. However, both treatments similarly decreased fasting and postprandial glucose, led to similar gut hormone responses, and had similar adverse event profiles.

FDA Approves Extended-Release Linagliptin/Metformin Combination

May 31, 2016. The US Food and Drug Administration has approved a once-daily, extended-release oral combination of the dipeptidyl peptidase-4 inhibitor linagliptin and metformin to treat adults with type 2 diabetes. The tablets combine 2.5 mg or 5.0 mg linagliptin with 1000 mg metformin. You can read the full article here.

December 9

The AACE Diabetes Resource Center is a compendium of educational tools that enable AACE members to take the lead in implementation of diabetes practice guidelines and also assist other members of their healthcare team in the formulation and delivery of education and guidelines with the goal of improving care for patients with diabetes in their communities.