COMMENTARY

Type 2 Diabetes: Three New Messages for Primary Care From ADA 2019

Jay H. Shubrook, DO

Disclosures

July 08, 2019

This transcript has been edited for clarity.

Hi. This is Jay Shubrook, family physician and diabetologist at Touro University. I am here at the 79th Annual Scientific Sessions of the American Diabetes Association (ADA) in San Francisco, California.

What are the three things that I think are the major takeaways from these sessions for primary care?

Type 2 diabetes in younger patients. We have some bad news. We know that type 2 diabetes is increasingly common in children and young adults, and that this disease is more virulent and progresses more quickly in those younger people. So look at the results of the Longitudinal Outcomes in Youth With Type 2 Diabetes (TODAY-2) trial.

(Editor's note: The results of the Restoring Insulin Secretion (RISE) trial in adolescents were also presented at ADA and provided sobering data on morbidity of type 2 diabetes in adolescents and young adults, described by one expert as "like watching a car crash in slow motion.")

Renal benefit from some antidiabetic agents. Second, we know that this is the year of the kidney. We have many studies that were presented here, including the REWIND and CREDENCE data, which showed that people with type 2 diabetes and kidney disease receive a substantial benefit from GLP-1 receptor agonists and SGLT2 inhibitors. Even those with advanced, stage 4 kidney disease benefit from these medications.

(Editor's note: Harpreet S. Bajaj, MD, MPH, and Akshay B. Jain, MD, provide more perspective on the implications of cardiovascular outcomes trials. )

Progression in newly diagnosed patients with diabetes. And then finally some good news. We are now finally seeing a change in the progression of new-onset diabetes. We're starting to see the incidence drop a little bit with a plateauing of the total number of people with diabetes, showing that we've made a difference in diabetes awareness and prevention.

(Editor's note: While the overall conclusion from the Vitamin D and Type 2 Diabetes (D2d) trial was that vitamin D did not prevent progression to type 2 diabetes, there were nuances to the results. Anastassios G. Pittas, MD, MS, the principal investigator, and Jay H. Shubrook, DO, discuss the implications of the trial on use of vitamin D in those with vitamin D deficiency .)

Three big takeaways:

  • Type 2 diabetes is bad in kids.

  • There are many medications now that are useful for nonglycemic benefits in type 2, including SGLT2 inhibitors and GLP-1 for nephropathy.

  • We're starting to head new cases of type 2 diabetes off at the pass with improvements in prevention.

Thanks for joining us today.

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