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Tag: Diabetes Management

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

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2017 ADA Standards of Medical Care in Diabetes Emphasize Psychological Health and Personalized Treatment Options

The newly published 2017 Standards of Medical Care in Diabetes by the American Diabetes Association emphasize psychological health, access to care, expanded and personalized treatment options, as well as hypoglycemia tracking in patients with diabetes as critical areas of focus.

In addition to screening, diagnosis, and treatment options, including metabolic surgery, that will provide better outcomes for patients with diabetes and information to improve the prevention/delay of type 2 diabetes, the guidelines also include data from a report that focused on beta-cell dysfunction and describes approaches to clarify specific subtypes of diabetes to facilitate personalized care.

The Standards also specifically include a recommendation to consider the use of empagliflozin in patients with type 2 diabetes and established cardiovascular disease to reduce the risk of cardiovascular death.

References:

ADA: 2017 Standards of Medical Care in Diabetes Released.

2017 Standards of Medical Care in Diabetes.

Boehringer Ingelheim and Lilly welcome new recommendation for Jardiance® (empagliflozin) tablets in updated American Diabetes Association’s 2017 Standards.