Cardiovascular outcomes trials investigating SGLT2 inhibitors have suggested benefits beyond glucose lowering that have been confirmed in real-world evidence studies (BMC Endocrine Disorders)
Diabetes News
Category: Medication
Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes
In this trial involving patients with type 2 diabetes, the cardiovascular risk profile of oral semaglutide was not inferior to that of placebo (NEJM)
Glycaemic benefit of iGlarLixi in insulin‐naive type 2 diabetes patients with high HbA1c or those with inadequate glycaemic control on two oral antihyperglycaemic drugs in the LixiLan‐O randomized trial
These results suggest that iGlarLixi achieves superior glycaemic control compared with iGlar or Lixi alone in T2DM patients with HbA1c ≥9% or those inadequately controlled on two OADs (Diabetes, Obesity and Metabolism)
Association of British Clinical Diabetologists (ABCD) position statement on the use of sodium-glucose cotransporter-2 inhibitors in type 1 diabetes (updated 2019)
The present ABCD position statement is to mitigate this risk and other potential complications in people taking these drugs. Particular caution needs to be exercised in people who are at risk of diabetic ketoacidosis due to low calorie diet, illnesses, injuries, starvation, excessive exercise, excessive alcohol consumption and reduced insulin admin-istration among other precipitating factors for diabetic ketoacidosis (ABCD)
Sodium–Glucose Cotransporter 2 Inhibitors: A Case Study in Translational Research
This review provides a physiological perspective to understanding the multiple actions of these drugs complemented by a clinical perspective toward balancing benefits and risks (Diabetes Care)
SGLT Inhibitors for Type 1 Diabetes: Proceed With Extreme Caution
The increase in absolute risk of DKA, even in closely supervised patients participating in clinical trials, raises a serious concern that DKA will be even more common if SGLT inhibitors are used in routine clinical practice by practitioners who do not have the expertise and resources of the clinical trialists to implement the complex recommendations necessary to mitigate risk for DKA (Diabetes Care)
Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review
Implementing strategies that are sensitive to local context and designed to increase adherence to insulin prescribing guidelines are associated with a reduction in prescribing errors. Future implementation should build on effective approaches including multifaceted interventions involving multiple stakeholders at various institutional levels (Diabetic Medicine)
Effect of liraglutide on cardiac function in patients with type 2 diabetes mellitus: randomized placebo-controlled trial
Liraglutide reduced early LV diastolic filling and LV filling pressure, thereby unloading the left ventricle. LV systolic function reduced and remained within normal range. Future studies are needed to investigate if liraglutide-induced left ventricular unloading slows progression of diabetic cardiomyopathy into symptomatic stages (Cardiovascular Diabetology)
A Randomized Study to Compare the Effects of Once-Weekly Dulaglutide Injection and Once-Daily Glimepiride on Glucose Fluctuation of Type 2 Diabetes Mellitus Patients: A 26-Week Follow-Up
Once-weekly dulaglutide injection has the same effectiveness as daily glimepiride on lowering blood glucose and decreasing oxidation stress and inflammation and is more effective in controlling glucose fluctuation as compared with glimepiride (Journal of Diabetes Research)
Implementation of Basal–Bolus Therapy in Type 2 Diabetes
A Randomized Controlled Trial Comparing Bolus Insulin Delivery Using an Insulin Patch with an Insulin Pen (Diabetes Technology and Therapeutics)
Semaglutide once weekly as add-on to SGLT-2 inhibitor therapy in type 2 diabetes (SUSTAIN 9): a randomised, placebo-controlled trial
Adding semaglutide to SGLT-2 inhibitor therapy significantly improves glycaemic control and reduces bodyweight in patients with inadequately controlled type 2 diabetes, and is generally well tolerated (The Lancet Diabetes & Endocrinology)
Update in Cardiovascular Safety of Incretin-Based Therapy in Adults with Type 2 Diabetes Mellitus: A Meta-Analysis of Cardiovascular Outcome Trials
This meta-analysis demonstrated that GLP-1RAs were associated with a significant reduction in MACE, CV death, stroke, and death from any cause, while DPP-4 inhibitors were comparable to placebo for all CV outcomes, including hospitalizations for HF (Canadian Journal of Diabetes)
Efficacy and safety of dual SGLT 1/2 inhibitor sotagliflozin in type 1 diabetes: meta-analysis of randomised controlled trials
In type 1 diabetes, sotagliflozin improves glycaemic and non-glycaemic outcomes and reduces hypoglycaemia rate and severe hypoglycaemia. The risk of diabetic ketoacidosis could be minimised by appropriate patient selection and down-titration of the basal insulin dose (BMJ)
DPP‐4 inhibitors lower the risk of autoimmune disease in patients with type 2 diabetes mellitus: A nationwide population‐based cohort study
In this large population‐based cohort study, upfront DPP4i combination therapy was associated with a lower risk of composite AD compared with initial non‐DPP4i combination therapy (British Journal of Clinical Pharmacology)
Impact of metformin use on the cardiovascular effects of dipeptidyl peptidase‐4 inhibitors: An analysis of Medicare claims data from 2007 to 2015
Incidence rate differences in multiple CV outcomes appeared more favourable when DPP‐4 inhibitor initiation occurred in the presence of metformin, suggesting a possible interaction between DPP‐4 inhibitors and metformin (Diabetes, Obesity and Metabolism)
Cost‐effectiveness of intensification with sodium‐glucose co‐transporter‐2 inhibitors in patients with type 2 diabetes on metformin and sitagliptin vs direct intensification with insulin in the United Kingdom
or UK patients with T2D not at goal on metformin and sitagliptin therapy, treatment intensification with SGLT2 inhibitors prior to NPH insulin is cost‐neutral or cost‐effective compared with immediate NPH insulin intensification (Diabetes, Obesity and Metabolism)
Double‐blind, randomized clinical trial comparing the efficacy and safety of continuing or discontinuing the dipeptidyl peptidase‐4 inhibitor sitagliptin when initiating insulin glargine therapy in patients with type 2 diabetes
When initiating insulin glargine therapy, continuation of sitagliptin, compared with discontinuation, resulted in a clinically meaningful greater reduction in HbA1c without an increase in hypoglycaemia (Diabetes, Obesity and Metabolism)
Safer insulin prescribing
This document summarises the evidence base on safer insulin prescribing. It is a key therapeutic topic that has been identified to support medicines optimisation. It is not formal NICE guidance
Type 2 diabetes mellitus: medicines optimisation priorities
This document summarises the evidence base on type 2 diabetes mellitus: medicines optimisation priorities. It is a key therapeutic topic that has been identified to support medicines optimisation. It is not formal NICE guidance
Effect of Additional Oral Semaglutide vs Sitagliptin on Glycated Hemoglobin in Adults With Type 2 Diabetes Uncontrolled With Metformin Alone or With Sulfonylurea
Among adults with type 2 diabetes uncontrolled with metformin with or without sulfonylurea, oral semaglutide, 7 mg/d and 14 mg/d, compared with sitagliptin, resulted in significantly greater reductions in HbA1c over 26 weeks, but there was no significant benefit with the 3-mg/d dosage. Further research is needed to assess effectiveness in a clinical setting (JAMA)
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