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On Site at the ADA: Insulin and Incretins Take Center Stage
Combination therapy that addresses both fasting and post-meal glucose elevation is the next big thing in T2DM management.
Today has been a long day! I have been busy with Diabetes Is Primary, a CME program for primary care physicians provided by the ADA. Some of the top experts in the country have spent the day presenting to primary care physicians (PCPs) on the basics of diabetes care. Topics ranged from use of insulin products to diabetic kidney disease to new products and therapies.
The most notable news from the conference thus far seems to be revolving around new incretins and new insulins. Sanofi revealed data from the EDITION studies showing that their U300 basal insulin was effective in lowering blood sugar with 21% fewer nocturnal hypoglycemic events. This product should allow lower dosing and longer action-meaning that the timing of insulin doses may be more flexible, also.
Another interesting presentation demonstrated that the new glucagon-like peptide-1 receptor agonist (GLP-1 RA) lixisenatide lowers the A1C by -0.77%, predominately by reducing postprandial glucose when used with basal insulin. This new product is largely a “prandial” GLP-1 RA-a drug that selectively reduces post-meal glucose excursion. It appears that incretins have varying impact on glucose-some produce more of a “basal” reduction throughout the day, while others produce a marked decrease in post-meal glucose elevations. Lixisenatide is the only once-a-day prandial GLP-1 RA presently available (approved in Europe).
An oral presentation outlined the effectiveness of a mixture that combines the long-acting insulin analog degludec (approved in Europe) with the GLP-1 RA liraglutide given as a single daily injection. This new product, IDegLira, was safe and effective in reducing A1C. This report, along with the data on lixisenatide, points to what is likely to be the future of type 2 diabetes therapy-basal insulin for fasting control combined with a GLP-1 RA for prandial control.
Tomorrow is another full day. The highlights will be the President’s lecture and the Banting Award lecture by this year’s recipient of the recognition for outstanding diabetes research. And there will be many more reports of new findings!
Charles F Shaefer, Jr, MD
6/21/2013Scroll down for links to blogs from the rest of the ADA meeting.
