New ADA Update: Liraglutide for Youth and Technology Issues

Miriam E. Tucker

August 02, 2019

Updates to the American Diabetes Association's (ADA's) Living Standards of Medical Care in Diabetes incorporate the recent approval of liraglutide (Victoza, Novo Nordisk) for youth with type 2 diabetes, new cardiovascular outcomes trial (CVOT) data for dulaglutide (Trulicity, Lilly), and new consensus recommendations for "time-in-range" using continuous glucose monitoring (CGM).

The updates, from the ADA's Professional Practice Committee, were published online July 31 in Diabetes Care. The revision pertaining to dulaglutide has also been endorsed by the American College of Cardiology.

Liraglutide Now Advised for Some Youth With Type 2 Diabetes

On the basis of the US Food and Drug Administration's approval in June of the injectable glucagonlike peptide–1 (GLP-1) agonist liraglutide for type 2 diabetes in youth aged 10 years or older, the section on children and adolescents (section 13) has been revised to say, "If glycemic targets are no longer met with metformin ± basal insulin, liraglutide therapy should be considered in children 10 years or older, if no history or family history of medullary thyroid carcinoma."

REWIND Data on Dulaglutide Added

Advice has also changed regarding the once-weekly GLP-1 agonist dulaglutide. The changes were based on new data from the Researching Cardiovascular Events With a Weekly Incretin in Diabetes (REWIND) trial, which were presented in June at the ADA's Scientific Sessions and were simultaneously published in Lancet.

Changes were made to the section on pharmacologic approaches to glycemic treatment (section 9) and the section on cardiovascular disease and risk management (section 10).

In section 9, dulaglutide is now included in the recommendation, "Use a GLP-1 receptor agonist with known CVD benefits." The recommendation notes that "dulaglutide showed superiority for [major adverse cardiac events] outcomes in large CVOTs...."

In a summary of cardiovascular outcomes trials, the following information was added: "Dulaglutide was also shown to decrease the risk of the primary composite outcome of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes in the [REWIND] trial, which enrolled individuals aged at least 50 years with either a previous cardiovascular event (30% of the trial population), subclinical atherosclerotic CVD (ASCVD), or cardiovascular risk factors (70% of the trial population). This benefit was consistent in the subgroups of patients both with and without prior CV event."

More details about REWIND have been added in section 10.

"Time-in-Range" Targets Make Use of CGM Data

Information has also been added in the sections about glycemic targets (section 6) and diabetes technology (section 7) regarding a newly recommended metric "time-in-range" obtained from CGM data. The addition is based on a new international consensus report that was released in June at the ADA Scientific Sessions and was simultaneously published in Diabetes Care.

For people with either type 1 or type 2 diabetes, the document advises that more than 70% of readings be within a blood glucose range of 70–180 mg/dL (3.9–10.0 mmol/L) and that less than 4% of readings be below 70 mg/dL (<3.9 mmol/L).

The consensus report was developed by a panel convened by the Advanced Technologies and Treatments for Diabetes Congress and was endorsed by several diabetes-associated societies, including the ADA, the European Association for the Study of Diabetes, and the nonprofit organization JDRF.

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