0

CMHC PULSE

Cardio Metabolic Health Congress – Official Blog

Follow-Up of EDICT Study Demonstrates Long-Term Efficacy of Initial Combination Therapy in T2DM Management

Type 2 diabetes mellitus (T2DM) affects approximately 28 million people in the United States and is characterized by hyperglycemia due to insulin resistance and impaired β-cell function. Its prevalence has almost doubled in the last two decades and diabetes costs the economy $245 billion annually; with most of these costs attributed to T2DM. The rapid increase in both the prevalence and associated healthcare costs underscores the need for optimizing treatment, as several pharmacological agents for T2DM are currently approved, with many more in development. Due to the progressive nature of T2DM, early initiation of combination therapy has been proposed as an approach to achieve better preservation of β-cell function.

The Efficacy and Durability of Initial Combination Therapy for Type 2 Diabetes (EDICT) study was a randomized trial to evaluate the efficacy and safety of initial triple combination therapy (metformin/pioglitazone/exenatide) compared to a conventional sequential therapy (metformin, followed by sequential add-on therapy of a sulfonylurea and basal insulin) in achieving glycemic control in T2DM patients. The original results from the EDICT study, published in 2015, demonstrated that early combination therapy in recently-diagnosed (<2 years) patients led to a greater reduction in HbA1c levels compared to conventional therapy, including a 1.2 kg mean weight loss (as compared to a 4.1 kg weight gain with conventional therapy) during a follow-up time of 24 months.1 A 6-year follow-up of this study was recently presented at the 2018 American Diabetes Association in Orlando, FL. In this follow-up, subjects that received initial triple therapy experienced significantly greater reductions in HbA1c compared to conventional therapy (mean HbA1c of 5.8% vs. 6.7%, p<0.001), with more patients achieving target HbA1c levels (<6.5%) in the triple therapy group (52%) compared to conventional therapy (25%).2 In addition, patients on initial triple therapy had improved β-cell function, less episodes of hypoglycemia, and weight loss. Progression of carotid intima media thickness, a measure of subclinical atherosclerosis, was also reduced by 50% in patients receiving triple therapy.2

Read more

Lifestyle Changes Help Reduce Cardiometabolic Risk

Chronic conditions now dominate healthcare, both in terms of expenditures and effects on patient quality of life. Over half of Americans have at least one diagnosed chronic condition. When solely considering cardiometabolic syndrome, 57.5% of Americans are estimated to have prediabetes, undiagnosed diabetes, or diabetes, and rates of metabolic syndrome continue to rise. To effectively treat this epidemic of chronic illness, and the overwhelming rates of cardiovascular disease, it is critical to arm both patients and providers with knowledge surrounding lifestyle modifications.

Christos S. Mantzoros, MD, professor of medicine at Harvard Medical School, recently confirmed the critical importance of investigating & researching lifestyle changes for cardiometabolic risk: including nutrition and adherence to healthy diets, sufficient exercise, smoking cessation, and other factors that can help mitigate cardiometabolic risk. “This is a very important topic that is often overlooked,” said Dr. Mantzoros at the Heart in Diabetes Clinical Education Conference. He clarified that it is often “cumbersome and time-consuming” for clinicians to dispense practical advice to patients, and many prefer to outsource to dietitians.

Yet given statistics that indicate over 30% of the country’s population is obese—and more than one-third are considered overweight—apathy is no longer an option. Mantzoros offered supplemental suggestions that could help patients reduce cardiometabolic risk, encouraging adherence to plant-based diets, the consumption of less trans and saturated fats; moderation of alcohol, and participation in physical activity & exercise.

Read more