In The News

Minimizing Glycemic Fluctuations in Patients With Type 2 Diabetes: Approaches and Importance

August 3, 2017. This review article examines the importance of and strategies for minimizing glycemic fluctuations in patients with type 2 diabetes (T2D). The authors note that measurements like A1C, fructosamine, and glycated albumin reflect a long-term average of plasma glucose and do not accurately measure short-term glycemic oscillations. Continuous glucose monitoring (CGM) more accurately monitors real-time glucose fluctuations.

FDA Grants Cardiovascular Indication for Liraglutide

August 25, 2017. The US Food and Drug Administration has granted a new indication for the diabetes drug liraglutide: to reduce the risk of major adverse cardiovascular (CV) events in adults with type 2 diabetes and established CV disease. This decision was based on data from the landmark LEADER trial, which found that adding liraglutide to standard of care reduced the risk of a composite CV endpoint by 13% vs placebo, representing a 1.9% absolute risk reduction (ARR). The LEADER trial also found a 22% reduction in CV death with liraglutide vs placebo (ARR 1.3%).

Sodium-Glucose Cotransporter-2 Inhibition Improves Incretin Sensitivity of Pancreatic β-cells in Patients With Type 2 Diabetes

August 8, 2017. This study evaluated whether the sodium-glucose cotransporter-2 (SGLT-2) dapagliflozin improved beta-cell incretin sensitivity by reducing glucotoxicity. In this 3-hour hyperglycemic clamp study, synthetic glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were infused to 19 subjects with type 2 diabetes (T2D) and 10 with normal glucose tolerance (NGT). Subjects with T2D were evaluated twice—before and 8 weeks after treatment with dapagliflozin; subjects with NGT were evaluated once.

Cardiovascular Mortality and Morbidity in Patients With Type 2 Diabetes Following Initiation of Sodium-Glucose Cotransporter-2 Inhibitors Versus Other Glucose-Lowering Drugs (CVD-REAL Nordic): A Multinational Observational Analysis

August 3, 2017. This real-world, clinical practice-based study was designed to compare cardiovascular (CV) mortality and morbidity in new users of sodium-glucose cotransporter-2 (SGLT-2) inhibitors compared with new users of other glucose-lowering drugs. The CVD-REAL Nordic multinational observational analysis evaluated data for all patients who filled a prescription for glucose-lowering drugs between 2012 and 2015 in Denmark, Norway, and Sweden.

Results of Real-World Study Show Dapagliflozin Decreases Cardiovascular Events and All-Cause Mortality Risk Compared to DPP-4 inhibitors in Patients With Type 2 Diabetes

August 3, 2017. The results of Dapagliflozin Compared to DPP-4 inhibitors is Associated with Lower Risk of Cardiovascular Events and All-cause Mortality in Type 2 Diabetes Patients (CVD-REAL Nordic) show that, in a real-world setting, patients who use dapagliflozin experience lower risk of hospital events for heart failure (HHF), major adverse cardiac events (MACE), and all-cause mortality compared with patients who receive dipeptidyl peptidase-4 inhibitors (DPP-4i).

Updated Self-Management of Diabetes Recommendations From the American Diabetes Association and the American Association of Diabetes Educators Integrate Education With Support

July 28, 2017. The American Diabetes Association (ADA) and American Association of Diabetes Educators (AADE) have updated their diabetes self-management guidelines to integrate the education and support aspects of care for patients with diabetes. Education and support were presented as 2 separate topics in previous ADA/AADE National Standards for Diabetes Self-Management Education and Support, published in 2014. These topics were combined to reflect the importance of ongoing support for patients with diabetes.

SGLT2 Inhibitors and Diabetic Ketoacidosis: Data From the FDA Adverse Event Reporting System

Regulatory agencies have reported a potential link between sodium-glucose cotransporter-2 (SGLT-2) inhibitor use and diabetic ketoacidosis (DKA). To examine this, investigators conducted a detailed analysis of DKA events observed in patients using SGLT-2 inhibitors, as reported to the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). FAERS data covered the first quarter of 2014 through the third quarter of 2016; data were evaluated using proportional reporting ratios (PRRs) and safety signals.

Metrics Beyond Hemoglobin A1C in Diabetes Management: Time in Range, Hypoglycemia, and Other Parameters

May 1, 2017. There is a need to incorporate new, more targeted metrics beyond A1C and self-monitoring of blood glucose (SMBG) to assess glycemia in patients with diabetes. This article (full text available through link above) reviews clinical instances in which A1C should not be used and reflects on the use of other glucose metrics that can be applied in substitution for or in combination with A1C and SMBG to tailor an individualized approach that will result in better patient outcomes.

FDA Advisors Support Adding New Cardiovascular Data to Liraglutide Label

June 20, 2017. The U.S. Food and Drug Administration’s (FDA) Endocrinologic and Metabolic Drugs Advisory Committee has reviewed a supplemental new drug application for liraglutide. Specifically, the manufacturer of liraglutide requested to update liraglutide’s labeling based on data from LEADER, a pivotal cardiovascular outcomes trial that evaluated >9,300 patients with type 2 diabetes at high risk of major cardiovascular events.

Shifting Paradigms in the Medical Management of Type 2 Diabetes: Reflections on Recent Cardiovascular Outcome Trials

June 26, 2017. Several novel type 2 diabetes (T2D) medications have recently shown promise in preventing cardiovascular (CV) disease. This review discusses the results of 4 recent randomized controlled trials of empagliflozin, pioglitazone, liraglutide, and semaglutide in preventing CV outcomes in patients with or at risk of T2D and with established CV disease. On the basis of these trials, the authors propose a paradigm shift in T2D management, particularly for patients with prior macrovascular disease.

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