Carol H. Wysham, MD


June 24, 2015

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Hello. I'm Carol Wysham. Here we are on the last day of the American Diabetes Association (ADA) 75th Scientific Sessions, and I am reflecting on highlights of the meeting.

First, it is always great to come to the meeting, interact with peers, and come with questions that I have for my own clinical practice. But the overall highlights were two cardiovascular safety studies. The ELIXA study[1] looked at lixisenatide, a GLP-1 receptor agonist in development. The investigators reported cardiovascular safety with their compound, so that is very reassuring. And finally, the long-awaited results of the TECOS study,[2] which looked at the cardiovascular safety of sitagliptin [Januvia®], were reported. Again, the results were neutral, meaning that there was no cardiovascular risk or benefit. The unique part of this particular presentation was that the authors were able to address the risk for hospitalizations for congestive heart failure. They did not show any increased risk for congestive heart failure, which is again very reassuring considering some of the earlier studies that have been reported.

What I am personally going to take home for my clinical practice are a couple of interesting basic science studies, which I think are very pertinent even to the general audience. One was a rodent study. The investigators induced severe hypoglycemia and showed that the risk for mortality was primarily related to cardiac arrhythmias.[3] They were able to block the mortality rate with the use of beta-blockers. In clinical practice, we previously said that we wouldn't use beta-blockers in patients with diabetes who are on insulin, but this may suggest a benefit.

And finally, a couple of different studies will cause me to change how I am approaching my patients with type 1 diabetes. Two studies on liraglutide [Victoza®] added to insulin in patients with type 1 diabetes showed no benefit in terms of hemoglobin A1c improvement.[4,5] I had been very enthusiastic about the potential benefit that liraglutide might have for my patients, but now I am less enthusiastic. Secondarily, there have been some reports of diabetic ketoacidosis after administering SGLT-2 inhibitors to patients with diabetes who are on insulin, with ketoacidosis occurring primarily in patients with type 1 diabetes.[6] Again, I was previously enthusiastic about the promise of adding this group of medications on top of insulin for my patients with type 1 diabetes, but now my level of enthusiasm for these adjunctive therapies is coming down. I think I will pause, wait, and see about additional information.


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