In The News

Cohort Study Identifies Patient Characteristics Associated With Severe Hypoglycemia

March 16, 2018. A retrospective cohort study using electronic medical records of 50,439 patients with type 2 diabetes in the Cleveland Clinic Health System was conducted between 2006-2015 to identify severe hypoglycemia events and associated risk factors. Incidence of severe hypoglycemia, defined as hospitalizations or emergency department visits for hypoglycemia, increased from 2006 to 2015 from 0.12% to 0.31% (P = 0.01).

IDegLira Is Effective in a Real-World Type 2 Diabetes Population

January 11, 2018. A European, retrospective chart review of adults (N=611) with type 2 diabetes evaluated the effect of IDegLira (a fixed-ratio combination of insulin degludec/liraglutide) on A1C, body weight, and other clinical characteristics ≥6 months after treatment initiation. Patients were stratified according to their baseline regimens: non-injectable therapies; glucagon-like peptide-1 receptor agonists (GLP-1 RAs) + oral antidiabetic drugs (OADs); combination insulin/GLP-1 RA + OADs; basal insulin + OADs; and multiple daily insulin injections (MDI) + OADs.

Several Diabetes Organizations Disagree With the American College of Physicians’ Recent Guidance on Blood Glucose Targets

March 9, 2018. The American Association of Clinical Endocrinologists (AACE), American Diabetes Association (ADA), American Association of Diabetes Educators (AADE), and The Endocrine Society (TES) have issued a statement strongly disagreeing with the recent guidance from the American College of Physicians (ACP) for A1C targets of 7% to 8% in adults with type 2 diabetes. This higher blood glucose target may put many patients at increased risk of complications, including cardiovascular disease, retinopathy, kidney disease, and amputation.

Diabetes Prevalence, Deaths, and Health Care Expenditures Worldwide: Estimates From the International Diabetes Foundation

February 26, 2018. The International Diabetes Foundation (IDF) performed a systematic literature review of studies published from 1990 to 2016 to estimate the 2017 worldwide prevalence of adult deaths attributable to and health care expenditures associated with impaired glucose tolerance (IGT), diabetes, and hyperglycemia in pregnancy. The IDF found that approximately 374 million adults have IGT and an estimated 451 million are living with diabetes. About 21.3 million live births in 2017 were to women with hyperglycemia.

Dulaglutide Superior to Placebo when Added to a Sodium Glucose Cotransporter-2 Inhibitor

February 23, 2018. The Assessment of Weekly AdministRation of LY2189265 (dulaglutide) in Diabetes-10 (AWARD-10) trial, a 24-week, phase 3b, double-blind, parallel-arm, placebo-controlled study, found the glucagon-like peptide-1 receptor agonist dulaglutide 1.5 mg (n=142) and 0.75 mg (n=142) significantly superior to placebo (n=140) in lowering A1C when added to any sodium glucose cotransporter-2 (SGLT-2) inhibitor, with or without metformin, in patients with uncontrolled type 2 diabetes.

Semaglutide Shows Greater Glycemic Control and Reduction in Body Weight Than Dulaglutide

January 31, 2018. This randomized, open label, parallel-group, phase 3b clinical trial evaluated the impact of dulaglutide vs semaglutide (both dipeptidyl peptidase-4 inhibitors) on A1C and body weight. For 40 weeks, participants with type 2 diabetes received either dulaglutide 0.75 mg (n=299), dulaglutide 1.5 mg (n=299), semaglutide 0.5 mg (n=301), or semaglutide 1.0 mg (n=300) in addition to metformin.

The Impact of Severe Hypoglycemia on Economic and Patient-Reported Outcomes

January 5, 2018. This observational, cross-sectional study found that reducing the frequency and severity of hypoglycemia could improve health-related quality of life (HRQoL) and reduce health care utilization and costs. Using data from the US National Health and Wellness Survey, the impact of hypoglycemia on health care resource utilization, HRQoL, work productivity and activity impairment, and estimated direct and indirect costs, were analyzed. Surveyed adults had type 2 diabetes and were using a basal insulin with oral antidiabetic drugs or rapid-acting/premixed insulins.

Updated Warning: FDA Warns of Diabetic Ketoacidosis and Serious Urinary Tract Infections with SGLT-2 Inhibitor Use

January 19, 2018. The US Food and Drug Administration (FDA) has identified further evidence supporting its May 2015 decision to revise the labeling for sodium-glucose cotransporter-2 (SLGT-2) inhibitors in patients with type 2 diabetes. Based on data submitted to the FDA’s Adverse Event Reporting System database, this update warns that use of these drugs may result in life-threatening diabetic ketoacidosis (DKA) and serious urinary tract infections (UTIs). In all identified cases (73 DKA and 19 UTIs), patients required emergency treatment or hospitalization.

Metformin Use Safe in Moderate-to-Severe Chronic Kidney Disease and Type 2 Diabetes

January 5, 2018. Three studies were conducted to establish a safe, effective metformin dose for patients with type 2 diabetes (T2D) and moderate (stages 3A/3B) to severe (stage 4) chronic kidney disease (CKD). First, a dose-finding study evaluated blood metformin concentrations over 1 week in response to dose increases. Appropriate daily dosages were found to be: 1,500 mg in CKD3A; 1,000 mg in CKD3B; and 500 mg in CKD4. Next, a treatment study monitored patient blood metformin, lactate, and A1C levels to validate the previously identified optimal metformin dosage for each CKD stage.

The Effect of Triple Therapy With Exenatide, Dapagliflozin, and Metformin on Cardiovascular Risk Factors in Patients With Type 2 Diabetes

January 5, 2018. DURATION-8 was a 28-week, phase 3, randomized controlled trial evaluating the efficacy and safety of exenatide once weekly (QW) + dapagliflozin vs either drug alone, all added to metformin monotherapy in 695 patients with type 2 diabetes. This post-hoc analysis grouped patients according to their baseline body weight, systolic blood pressure (SBP), and triglyceride levels and then assessed the impact of exenatide QW + dapagliflozin, exenatide QW, or dapagliflozin on these risk factors.

Incretin-Based Therapies Do Not Increase Pancreatic Cancer Risk Among Patients With Type 2 Diabetes

January 3, 2018. This meta-analysis of 33 randomized controlled trials of ≥52 weeks’ duration in 79,971 individuals with type 2 diabetes evaluated the risk of pancreatic cancer in patients using incretin-based therapies vs placebo or other antidiabetic drugs. A total of 87 pancreatic cancer events were observed.

FDA Permits Marketing of Dermapace System to Treat Diabetic Foot Ulcers

December 28, 2017. The US Food and Drug Administration (FDA) has approved the marketing of the Dermapace System for adult patients with diabetic foot ulcers. This device is approved to treat chronic, full-thickness diabetic foot ulcers ≤16 cm2 that do not involve bone exposure. The Dermapace System mechanically stimulates foot ulcers via the use of energy pulses, similar to sound waves. In 2 double-blind, randomized, multicenter studies, 44% of patients treated with Dermapace experienced wound closure at 24 weeks, compared with 30% of patients who received sham treatment.

AACE Resource Center

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.