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Congress Report: American Diabetes Association 75th Scientific Sessions

Congress Report: American Diabetes Association 75th Scientific Sessions
  • Endocrinology and metabolism
  • Diabetes

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Article

Tags

american diabetes association
ADA
Trials
Diabetes
T2DM
Acute coronary syndrome
Lixisenatide
Sitagliptin
Cardiovascular (CV) risk
CV benefit
Guidelines
American College of Cardiology
American Heart Association
Lipid management
Statin therapy
Healthy lifestyle
screening
Diabetes self-management education and support
DSME/S
Treatment algorithm
Improving treatment outcomes
Reducing diabetes-related costs

Professor Chaicharn Deerochanawong reports on the highlights from the meeting held 5–9 June 2015 in Boston, MA, USA

Neither lixisenatide nor sitagliptin caused a cardiovascular (CV) risk or benefit in two CV trials

ELIXA is the first CV outcome trial for a glucagon-like peptide-1 (GLP-1) agonist class drug (lixisenatide). In all, 6068 type 2 diabetes mellitus (T2DM) patients with acute coronary syndrome were followed for ~2 years.

Lixisenatide was associated with no risks or benefits on the CV composite (CV death, all-cause mortality), and hospitalisation for heart failure. Lixisenatide showed a modest benefit for weight control, with no increase in the risk for hypoglycaemia, pancreatic injury or cancer.

In the TECOS trial (>14,000 patients with average 3-year follow-up), the dipeptidyl peptidase 4 (DPP-4) inhibitor, sitagliptin, had no adverse CV effects, including the risk of hospitalisation due to heart failure. But gave no CV benefits.

The primary outcome – a composite of CV outcomes – occurred in 11.4% of patients in the sitagliptin group (4.06 per 100 person-years) vs 11.6% on placebo (4.17 per 100 person-years).

Guidelines offer different advice on lipid management but agree on the importance of healthy diet and lifestyle

Differences in the American Diabetes Association (ADA) and American College of Cardiology / American Heart Association (ACC/AHA) guidelines for lipid management were discussed. The ADA update on hyperglycaemia management in T2DM patients was also considered.

The ADA endorsed the ACC/AHA guidelines but retained some recommendations based on expert opinion not in the ACC/AHA document.

The ADA, but not the ACC/AHA, recommends screening lipid profile at:

  • Diabetes diagnosis
  • The initial medical evaluation
  • And/or at age 40 years and then every 1–2 years.

 

Both groups emphasise a heart-healthy lifestyle and diet. The ADA continues to specifically recommend intake of omega 3 fatty acids, viscous fibre and plant sterols. 

ACC/AHA use a graded approach for statin therapy, considering presence of heart disease, age and risk. ACC/AHA guidelines do not set target cholesterol levels, unlike the ADA, based on different sources of evidence.

Combination therapy (statin and fibrate) is recommended by the ADA in some situations, in contrast to the ACC/AHA, based on recent study results.

Diabetes self-management education and support could improve patient outcomes and reduce costs associated with diabetes and its complications

A joint diabetes self-management education and support (DSME/S) position statement was released by the ADA, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. It provides an algorithm with guidance for healthcare providers on when to refer T2DM patients to certified diabetes educators (CDEs) and other trained staff for education and support.

The algorithm refers to the ADA’s Standards of Medical Care in Diabetes in recommending that all T2DM patients be assessed and referred for further evaluation in several areas:

  • Nutrition counselling by a registered dietitian
  • Education in diabetes self-management and support
  • Emotional health – counselling by a mental health professional, if needed.

 

The algorithm recommends that DSME/S is considered at diagnosis, annually, when new complicating factors influence self-management, and when transitions in care occur.

Specific situations for primary care providers and specialists to consider are given.

The benefits of DSME/S could include:

  • Improvement in outcomes for patients with diabetes, according to the position statement
  • Cost-effectiveness in reducing hospital admissions and readmissions
  • Lowering lifetime healthcare costs related to complications.

 

Cover image courtesy of freedigitalphotos.net

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