ADA Take-Aways: Assail Obesity, Stay the Course With Incretins

June 26, 2013

Bariatric surgery is recommended along with oral therapy to help patients with type 2 diabetes control overweight and obesity.

Today was the last day of the 73rd Scientific Session of the American Diabetes Association. It has been an interesting and invigorating week. Of greatest interest to me today was the symposium on clinical management of obesity in diabetes. The new American Association of Clinical Endocrinology guidelines call for assessment and management of obesity in diabetes. While the process of obesity management starts with intensive lifestyle change, the symposium today suggested use of oral agents or even bariatric surgery to achieve the goal of weight control. The message was that obesity management must be a proactive part of any diabetic therapy plan.

So what was accomplished at the 2013 Scientific Sessions? There were not many new therapies introduced. We did learn a lot more, though, about the treatments we do have, such as insulins, GLP-1 RAs, DPP-4 inhibitors, and SGLT2 inhibitors. The GLP-1 RAs, DPP-4 inhibitors, and SGLT2 inhibitors offer little or no risk of hypoglycemia and are weight neutral (DPP-4 inhibitors) or even weight reducing (SGLT2 inhibitors and GLP-1 RAs). There is no doubt that there is a strong clinical move in the direction of these newer therapies.

While the question of incretin safety still lurks in the shadows, there was consensus among meeting attendees that there is no cause for over concern about using these agents.The speaker who presented data about incretin safety polled the audience after her excellent review of the literature about whether they would or would not discontinue use of these drugs in their practice. Of the several thousand attendees, all but a handful said they would inform their patients of the controversies around incretins, but continue their use. It seems that it is just too hard with available data to tease out “incretin caused” pancreatitis and pancreatic cancer from these conditions that are inherent to diabetes alone. This presenter called for definitive studies to clarify the safety issues and those are currently under way.

Of my colleagues unofficially questioned in the Chicago airport this afternoon the consensus was that it was a very good meeting full of new information but relatively short on innovation. Perhaps a little bit of time to reflect and catch our breath between innovations is not so bad. The development of new therapeutic classes of diabetic treatment has been occurring at breakneck speed. Maybe now is the time to evaluate what we have and learn how to use our tools to achieve patient centered diabetic care.

Charles F. Shaefer Jr, MD
6/25/2013
 
Scroll down for links to blogs from the rest of the ADA meeting.