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Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018
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Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
The latest research in managing type 1 and 2 diabetes, including new data on the glucagonlike peptide-1 (GLP-1) agonists albiglutide and lixisenatide, the dipeptidyl peptidase-4 (DPP-4) inhibitor linagliptin, and a novel dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 agonist dubbed a "twincretin" greeted attendees here at the European Association for the Study of Diabetes (EASD) 2018 Annual Meeting, held October 1 to 5 in Berlin, Germany. The meeting also featured the final version of new American Diabetes Association (ADA)-EASD guidelines on patient-centered type 2 diabetes management. "You can't simply look at all the science...The patient has to be at the center of all of this," commented incoming EASD president David R. Matthews, MD.
Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
Highlights
Among the highlights this year:
HARMONY: Albiglutide Cuts CV Events but Not Deaths in Diabetes
CARMELINA: Linagliptin Reassures for DPP-4 Inhibitors in Diabetes
Twincretin, a Dual GIP/GLP-1 Agonist, Excites in Type 2 Diabetes
System Improves Less-Than-Ideally Controlled Type 1 Diabetes
Insulin at Risk From Variable Temperatures of Home Refrigerators
Lixisenatide Renal Benefit in Diabetes With Macroalbuminuria
Cutting Carbs in Morning Equals Better Weight Loss, Waist Size
EASE: Empagliflozin Beneficial in Type 1 Diabetes, DKA a Risk
Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
HARMONY: Albiglutide Cuts CV Events but Not Deaths in Diabetes
The GLP-1 receptor agonist albiglutide (Tanzeum, GlaxoSmithKline) significantly reduces major adverse cardiovascular events (MACE) in type 2 diabetes patients with established cardiovascular disease (CVD) compared with placebo without any additional safety concerns, according to the results of the latest post-approval cardiovascular outcomes study of a diabetes drug. The HARMONY Outcomes study, led by Adrian F. Hernandez, MD, Duke Clinical Research Institute, Durham, North Carolina, and included almost 9500 patients treated with albiglutide or placebo for more than 1.5 years against a background of standard diabetes and CVD medication, showed that the benefit was largely driven by a significant reduction in myocardial infarctions. "These results...add to the evidence that certain GLP-1 receptor agonists reduce cardiovascular events in patients with type 2 diabetes," said session chair Stefano Del Prato, MD, of University of Pisa, Italy. GlaxoSmithKline ceased all manufacturing and sales of albiglutide in 2017 for commercial reasons, but has now said it will seek a new home for the drug.
Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
CARMELINA: Linagliptin Reassures for DPP-4 Inhibitors in Diabetes
Adding the dipeptidyl peptidase-4 (DPP-4) inhibitor linagliptin (Tradjenta, Lilly/Boehringer Ingelheim) to standard of care in patients with type 2 diabetes at high CV risk has no impact on CV, heart failure, or renal events, even in those who already have chronic kidney disease (CKD), show data from the CARMELINA postmarketing outcomes study. The trial involved almost 7000 patients with type 2 diabetes and CV risk factors from 27 countries, three quarters of whom also had CKD. The patients were randomly assigned to linagliptin or placebo plus standard of care and were treated for 2 years. The primary outcome of three-point MACE did not significantly differ between linagliptin and placebo. Rates of a prespecified combined renal endpoint did not differ between the study drug and placebo but there was a significant reduction in microvascular events with linagliptin. "One can conclude that, in this patient population, linagliptin demonstrated cardiovascular safety for atherosclerotic cardiovascular events and a neutral effect on hospitalization for heart failure and kidney outcomes," reported Bernard Zinman, MD, from the University of Toronto, Ontario, Canada.
Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
Twincretin, a Dual GIP/GLP-1 Agonist, Excites in Type 2 Diabetes
A novel GIP/GLP-1 receptor dual agonist combined into a single drug (LY3298176, Lilly), dubbed a "twincretin," shows average declines in HbA1c of up to 2.4% and weight loss of up to 11.3 kg (24.9 lb), according to 6-month data in patients with type 2 diabetes. "These phase 2b clinical trial results for GIP/GLP-1 receptor agonist are unprecedented, and the impressive blood glucose and weight reductions seen may lead to a new treatment option for people with type 2 diabetes," said principal investigator Juan Pablo Frias, MD, from the National Research Institute, Los Angeles, California. The clinically meaningful effects on glucose lowering and weight loss of the dual GIP/GLP-1 receptor stimulation, compared with selective agonism of the GLP-1 receptor, suggests "its potential for greater metabolic effects versus selective GLP-1 receptor stimulation, especially for weight reduction," Frias and colleagues said in their article published in The Lancet to coincide with the presentation. "In my experience as an investigator and clinician, I have never seen this magnitude of HbA1c reduction, in this percentage of patients, who are normalizing their glucose, and with this level of weight loss too, which is certainly more than with dulaglutide [a GLP-1 agonist]," said Frias.
Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
Personalize Diabetes Therapy, New EASD-ADA Guidelines Stress
New consensus guidelines on patient-centered type 2 diabetes management have now been published for clinicians in Europe and the United States. The final version of the consensus document by the ADA and EASD was presented here and simultaneously published in both Diabetologia and Diabetes Care. The guidelines emphasize that all treatment decisions be made in collaboration with the patient. "You can't simply look at all the science...The patient has to be at the center of all of this. You need key patient characteristics, you consider the factors, you share the decision-making, agree on management, and you go round and round…because our science is held by human hands," said incoming EASD president David R. Matthews, MD. Report coauthor Chantal Mathieu, MD, PhD, of University Hospital Gasthuisberg Leuven, agreed. "We should assess key patient characteristics and consider specific factors that will impact choice of treatment, and then come to shared decision-making to create a management plan. What is important is that the patient agrees on this plan, and that this plan is revised over and over and over again as the life of the patient progresses," she stressed.
Image from iStock
Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
System Improves Less-Than-Ideally Controlled Type 1 Diabetes
An investigational "hybrid closed-loop" insulin delivery system improved blood glucose control and reduced the risk for hypoglycemia in adults and children as young as age 6 with suboptimally controlled type 1 diabetes. One such system, Medtronic's MiniMed 670G, was approved in the United States in 2016 based on data from a nonrandomized safety trial of 124 patients with type 1 diabetes aged 14 to 75 years. Martin Tauschmann, MD, of University of Cambridge, United Kingdom, reported results of a new randomized trial investigating use of a different algorithm developed at Cambridge University. Participants were adults and children with HbA1c 7.5% to 10.0% despite using an insulin pump. The proportion of time spent in target glucose range of 3.9 to 10.0 mmol/L (70 to 180 mg/dL) was 10.8% higher in patients in the hybrid closed-loop group than in the control group using sensor-augmented pump therapy alone (65% vs 54%). Hypoglycemia was significantly lower with the closed-loop system and there were no episodes of severe hypoglycemia in either group. "Overall," said Tauschmann, "you can say hybrid-closed loop systems are safe, but you can't really say one algorithm is better than another...You might get different results with different algorithms, but all perform better than what's available now with just a pump and a sensor."
Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
Insulin at Risk From Variable Temperatures of Home Refrigerators
Domestic refrigerators fail to keep insulin within the manufacturer-recommended temperature range in a significant number of cases, raising the possibility that refrigerators may pose an underestimated risk for insulin quality, suggests an observational study conducted in the United States and Europe. "Nearly every dataset relating to fridge storage showed excursions from the recommended range that are below 2° C and above 8° C, and even some excursions below 0° C. We were surprised that every dataset showed this pattern," said Katarina Braune, MD, from Charité-Universitaetsmedizin, Berlin, Germany. She noted that the study did not examine how variations in storage temperature might affect the performance of insulin and the consequent effect for patients. "If the effect is 100% lost — for example, if the insulin is frozen — it might not have the glucose-lowering effect required," she explained. Bernhard Gehr, MD, of Fachklinik Bad Heilbrunn, Germany, said: "The study is important because it was conducted in the real world and it highlights significant potential problems with insulin safety."
Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
Lixisenatide Renal Benefit in Diabetes With Macroalbuminuria
The injectable GLP-1 agonist lixisenatide (Lyxumia, Sanofi) may protect patients with type 2 diabetes who have CVD from developing kidney damage, although the effect is most pronounced in those who already have macroalbuminuria, suggests a post-hoc analysis of the ELIXA trial. The urinary creatinine-to-albumin ratio was significantly reduced by 39% in patients with type 2 diabetes and macroalbuminuria who took lixisenatide compared with placebo, and a borderline significant 21% for the same comparison in those with microalbuminuria, reported Marcel Muskiet, MD, from VU University Medical Center Amsterdam, the Netherlands. He said the "effect on albuminuria progression is maintained after adjustment for the traditional risk factors, namely HbA1c, systolic blood pressure, and body weight." So "in patients with type 2 diabetes without severe renal impairment but with a recent acute coronary syndrome, the addition of lixisenatide to usual care...improved the burden of micro- and macroalbuminuria beyond glycemic control."
Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
Cutting Carbs in Morning Equals Better Weight Loss, Waist Size
Restricting carbohydrate in the morning, coupled with a low-calorie Mediterranean diet, led to improved weight and fat loss, lower BMI, and reduced waist circumference compared with the Mediterranean diet alone in a small study from Greece. The morning carbohydrate-restricted diet group consumed between 300-500 kcal of very low carbohydrate foods divided between breakfast and midmorning snack. The Mediterranean diet (control) comprised 300 kcal of typical Mediterranean foods divided between breakfast and midmorning snack. The two diets were identical for the rest of the day and comprised typical Mediterranean foods. Mean calorie intake was 1300-1500 kcal/day for both diets. Both diets had the same effect on glycemic outcomes in obese and overweight patients, a third of whom also had type 2 diabetes, but the morning carbohydrate-restricted diet produced slightly worse outcomes with regard to lipids compared with the Mediterranean diet alone. "The morning carbohydrate-restricted diet might offer certain benefits by favoring compliance...and the rapid weight lowering seen with this diet might be used in the induction of longer-term diets or be an add-on feature in weight maintenance, even though it wasn't tested for this," said Dimitrios Tsilingiris, MD, from National and Kapodistrian University of Athens, Greece.
Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
Sweeteners Disrupt Blood Glucose Via Effects on Gut Bacteria
Low-calorie sweeteners appear to impair glucose uptake and control by disrupting the gut microbiome, suggesting that artificial sweeteners could potentially play havoc with glucose-lowering medications in patients with diabetes. In a study of healthy individuals, Richard L. Young, PhD, head of the Intestinal Nutrient Sensing Group, University of Adelaide, South Australia, and colleagues showed that a low-calorie sweetener capsule altered the gut ecosystem in favor of pathogenic bacteria compared with placebo. Young said that "2 weeks' supplementation with sweeteners in capsules increases glucose absorption and glycemic responses to glucose, and decreases glucose-evoked increases in the incretin GLP-1." He added, "I hope I've convinced you that [sweeteners] trigger changes in the gut microbiome, including its functional properties." Asked by Medscape Medical News whether, based on their impact on GLP-1 levels, low-calorie sweeteners could affect the efficacy of diabetes medications, he said, "There's definitely the possibility that they could interact."
Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
EASE: Empagliflozin Beneficial in Type 1 Diabetes, DKA a Risk
The SGLT2 inhibitor empagliflozin (Jardiance, Boehringer Ingelheim/Eli Lilly) improved glycemic control and weight in type 1 diabetes, but also increased the risk for diabetic ketoacidosis (DKA), according to data from the Empagliflozin as Adjunctive to Insulin Therapy (EASE) program. The new results come from two double-blind, placebo-controlled phase 3 trials: EASE-2, with 730 patients with type 1 diabetes and HbA1c 7.5% to 10.0% randomized to 10 mg or 25 mg of empagliflozin daily or placebo for 52 weeks, and EASE-3, with 734 similar patients randomized to 2.5 mg, 10 mg, or 25 mg of empagliflozin or placebo daily for 26 weeks. Overall, empagliflozin significantly improved glycemic control and weight without increasing hypoglycemia, but the 10-mg and 25-mg doses — the two currently approved for treating type 2 diabetes — were associated with a three- to four-fold increased risk for DKA as well as genital infections. Study coauthor Lori M. Laffel, MD, of the Joslin Clinic, Boston, Massachusetts, noted that SGLT2 inhibitors represent an opportunity for meeting unmet needs in type 1 diabetes — in terms of managing both glycemia and weight — and she offered recommendations for mitigating the DKA risk associated with SGLT2 inhibitors.
Top News From EASD 2018: Slideshow
Lisa Nainggolan; Darbe Rotach; Liam Davenport; Becky McCall; Miriam E. Tucker; Megan Brooks | October 19, 2018 | Contributor Information
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Contributor Information
Lisa Nainggolan
Medscape Diabetes & Endocrinology News Editor
Darbe Rotach
Medscape Senior Photo Editor
New York City
Liam Davenport
Freelance Journalist
UK
Becky McCall
Freelance Journalist
UK
Miriam E. Tucker
Freelance Journalist
Bethesda, Maryland
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