New Insights into Management
The American Diabetes Association's (ADA's) 77th Annual Scientific Sessions just concluded in San Diego. Much of the attention deservedly went to some of the groundbreaking clinical trial results released at the meeting, but the conference was also notable for literally hundreds of smaller studies featured in the posters section. Although selecting just a few to feature was difficult, we bring you a sampling of the amazing workgoing on under the radar.
Changing Meds for All the Wrong Reasons
What happens to patients who have to change their antihyperglycemic medication because of financial reasons, such as an insurer no longer paying for their particular drug? In a study looking at self-reported data from 451 patients with type 2 diabetes (T2DM), Natalia Flores, PhD, a health outcomes research manager at Kantar Health, and colleagues asked patients how the switch made them feel and how it affected their diabetes. Patients in the survey were 59 years old on average, about one half were women, and one quarter were covered by Medicaid.
As a whole, the forced changed in medication was most often associated with reports of feeling very/extremely frustrated, surprised, upset, and angry. More than 20% of patients reporting a negative impact on blood glucose level, diabetes, and general health. A small number, fewer than 1 in 10, reported old symptoms returning, and about 14% experienced new side effects. Overall, though, similar numbers of patients reported satisfaction with both their old and new medication. So although the change may be unwelcome and certainly requires close monitoring during the transition, most patients end up reasonably happy with the new drug—which is good news, because most clinicians probably won't be able to prevent the change.
Factors That Make the A1c Go Down
The MOSAIc (Multinational Observational Study Assessing Insulin use) study is a multinational observational cohort study that seeks to identify factors associated with insulin progression in patients with T2DM. Several patient, physician, and healthcare system factors were found to be predictive of a reduction in A1c > 0.5%, or achievement of a patient's therapy goal and therefore no necessity for intensification of insulin therapy. Several baseline characteristics were more likely in this group; these included Hispanic or Latino ethnicity, macrovascular complications, at least one hypoglycemic episode in the month before study entry, a lower A1c value, a nonendocrinologist physician, and public health insurance.
Oral Agents Versus Insulin as First-Line Therapy
Initiation of insulin in patients with a severely elevated A1c can be difficult in low-income settings, where negative perceptions of the drug are a real barrier. Elizabeth Vaughn, DO, and colleagues at CHI St. Luke's Health-Patients Medical Center conducted a retrospective chart review of almost 500 adult patients seen in low-income community clinics with newly diagnosed T2DM to determine how A1c levels changed at 12 months for those placed on oral agents (82%) versus those initially treated with insulin (18%).
In a subset analysis of only patients with A1c > 11% at diagnosis, the investigators found no statistically significant differences in A1c levels at 1 year (insulin-treated group, -5.06%; oral agent-treated group, -4.62%). The insulin-treated group did, however, have more emergency department visits per year, and that difference achieved statistical significance. The authors concluded that oral agents are as clinically effective as insulin, even in this group with markedly elevated A1c levels.
Long-term Weight Loss After Bariatric Surgery
Bariatric surgery is increasingly recognized as an important tool in the fight against adolescent obesity. However, long-term results are lacking. Justin R. Ryder, PhD, of the University of Minnesota, and colleagues followed 50 teens who underwent Roux-en-Y gastric bypass surgery, collecting anthropometric data and questionnaires to assess diet, activity, and quality of life at least 5 years (mean, 8 ± 2 years) after surgery. These youth were then compared with a control group recruited at a weight management clinic who were not treated surgically.
Approximately one half of the surgical group maintained their weight within 20% of their nadir, and weight-loss outcomes were superior in those treated surgically. Of note, no behavioral factors, such as eating behavior or physical activity, were strongly associated with maintenance of weight loss. The one factor that was strongly associated with success? Self-reported improvement in quality of life.
Factors Associated With Retinopathy
Young-adult onset of T2DM is recognized to be a particularly aggressive condition, but the incidence of microvascular complications, and particularly retinopathy, in this subset of patients has not been well studied. Timothy Middleton and colleagues at the University of Sydney examined data in the RPAH Diabetes Centre Database collected between 1990 and 2016 to compare microvascular complication rates (retinopathy, microalbuminuria, peripheral neuropathy) in patients with onset of T2DM between 15 and 69 years of age. The odds of retinopathy 10-15 years after a T2DM diagnosis were greatest in those with onset between the ages of 15 and 30 years (odds ratio, 6.0; P = .02). Clearly, annual eye screening must be prioritized in this subset of patients.
Medscape Diabetes © 2017 WebMD, LLC
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Cite this: Poster Pearls From ADA 2017: 13 New Things You'll Be Glad You Know - Medscape - Jun 20, 2017.