Stefano del Prato, MD


October 23, 2012

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Hi. My name is Stefano del Prato. I am Professor of Endocrinology at the University of Pisa and Vice President of the European Association for the Study of Diabetes. I am speaking from Berlin, for the 48th Annual Meeting. As you can imagine, it is a busy time. But it is also time for plenty of new data, new information, and lots of discussion. I would like to emphasize the novelties that are looming on the horizon in terms of new potential treatments for type 2 diabetes.

As expected, there are more and more data regarding the GLP-1 receptor agonists, and there are more and more data on DPP-4. But there are also very important data regarding the SGLT-2 inhibitors. These drugs, as you may know, reduce the ability of the kidney to reabsorb glucose, and because of that, more glucose appears in the urine. Through this very simple mechanism you can reduce blood glucose. Reducing blood glucose, in turn, will reduce the blood glucose toxicity, and reducing glucose toxicity is expected to improve insulin secretion and insulin action. This treatment is also of interest because it is associated with a very low risk for hypoglycemia. It is also associated with a certain degree of weight loss -- easy to understand because glucose is lost in the urine, so for each gram of glucose, 4 calories are lost. There is also an interesting reduction of blood pressure.

Obviously, there are also some side effects that are important to be aware of, such as the recent report of an increased risk in urinary tract infections and genital infections. What is the real implication of all this? It's tough to say.

Dapagliflozin has not been approved in the United States, but it's been approved by the European Medicines Agency. So, I think that we’ll be seeing in the future how much these new drugs can provide us in terms of improving glycemic control in type 2 diabetic individuals.

However, these aren't the only news. There are other new drugs, or new formulations in terms of insulin. Degludec is an insulin that Novo Nordisk has presented many data about here. It's a long-lasting insulin that possibly -- based on the data made available here at the Congress -- is able to provide good glycemic control, reducing fasting plasma glucose concentration with very low risks, actually lower than with insulin glargine, with which it has been compared in terms of nocturnal hypoglycemia.

But it's not only that. I think that what has appeared here in the sessions of EASD are all new potential venues for new forms of treatment. A new molecular defense has been recently identified that could become an important target for treatment. There are data -- mainly empirical data in animals, but they are very exciting. For instance, there are drugs that potentially are able to activate the insulin receptor instead of insulin itself. There are drugs that potentially may modulate the persistence of the signal at the level of the insulin signaling pathway and thus increase insulin sensitivity.

All of these new drugs seem to be associated not only with an improvement in glucose control, but also with a reduction in the fat in the liver. As you may know, NASH, NAFLD, and hepatic steatosis are new cardiovascular markers that are becoming more and more important.

I think that this is a very exciting time, and to understand just how exciting it is, we have to remember that 10 years ago, we only had 2 drugs on top of insulin: metformin and sulfonylurea. Now in the States, there are 13 classes of drugs for the treatment of type 2 diabetes. Is it good? Is it bad? I think it's good, but I think also that we need to understand the complexity of the treatment of type 2 diabetes and the importance of addressing the specific needs of each individual patient. Thank you very much.