132
VOLUME 9 NUMBER 3 • SEPTEMBER 2012
ADA WATCH
SA JOURNAL OF DIABETES & VASCULAR DISEASE
infarction (MI) or stroke, and secondly, the
composite of these events plus either a
revascularisation procedure or hospitalisa-
tion for heart failure, there was no signifi-
cant difference between the two groups.
The incidence of a first episode of severe
hypoglycaemia was a modest 1.00 per 100
person-years in the insulin glargine-treated
group, and 0.31 per 100 person-years in
the standard-care group (
p
< 0.001). Partic-
ipants in the insulin glargine group gained
a median of 1.6 kg, whereas the standard-
care group lost a median of 0.5 kg.
Source: 1. The ORIGIN trial investigators. Basal insu-
lin and CV and other outcomes in dysglycemia.
N
Eng J Med
.
Epub 11/6/2012. DOI: 10.1056/NEJ-
Moa1203858.
2.
Cardiovasc J
Afr e-alert, Origin trial, 15 June 2012.
‘
Real-world’ study of liraglutide
versus twice-daily exenatide and
DPP-4 inhibitors
New ‘real-world’ data showed that liraglu-
tide injection provided greater reduction
in HbA
1
c
levels compared to exenatide and
DPP-4 inhibitors, with weight loss and cost-
effectiveness, when used in routine primary
care, according to current UK type 2 diabetes
treatment guidelines. The study presented at
the 72nd annual scientific sessions also shows
that more patients appeared to favour a drug
with a liraglutide-like profile, which is given
by injection, over a drug with a sitagliptin-like
profile, which is given orally.
‘
This study shows us that the results
we’ve seen with liraglutide in clinical trials
are reflected in day-to-day, real-world use’,
said Marc Evans, study investigator from
Llandough Hospital, Cardiff, Wales. ‘Key to
managing diabetes is choosing treatments
that patients will adhere to in order to get
the best outcomes.’
The study analysed data from 1 114
type 2 diabetes patients from primary care
practices in the UK and assessed the clinical
efficacy and patient preference with regard
to liraglutide, exenatide and DPP-4 inhibi-
tors. Key findings from the study were:
The results showed that greater reduc-
•
tion in HbA
1
c
level was seen in patients
treated with liraglutide compared to
exenatide or DPP-4 inhibitors (1.23
± 0.14%, 0.79 ± 0.19% and 0.72 ±
0.23%,
p
< 0.05,
n
= 1 114).
Significantly greater weight loss was
•
seen in patients treated with liraglutide
(
n
= 256) compared to DPP-4 inhibitors
(
n
= 710) (–3.9 ± 5.7 vs –0.8 ± 3.1 kg,
p
< 0.05). Greater weight loss was seen
in patients treated with liraglutide (
n
=
256)
compared to exenatide (
n
= 148)
(–3.9
± 5.7 vs –2.9 ± 5.8 kg).
More patients expressed a preference
•
for a drug with a liraglutide-like profile
over one with a sitagliptin-like profile
(62.5
vs 37.5%,
p
< 0.05).
The calculated life years gained per
•
patient were 0.12, 0.08 and 0.07 years
for those receiving liraglutide, exenatide
or a DPP-4 inhibitor, respectively, com-
pared to their respective baselines.
Based on observed treatment effects,
•
the United Kingdom Prospective Dia-
betes Study (UKPDS), 68 risk equations
were applied over a 20-year time hori-
zon to calculate cost effectiveness. The
observed cost/QALY (quality-adjusted
life years) vs baseline for patients
receiving liraglutide, exenatide or a
DPP-4 inhibitor was £16 505, £16 648
and £20 661, respectively. Costs were
calculated using the most commonly
prescribed DPP-4 inhibitor, sitagliptin.
BARI 2D study adds insights on
glycaemic control strategies and
peripheral neuropathy
The BARI 2D study which showed similar
long-term cardiovascular outcomes whether
the glycaemic control strategy was insulin-
sensitising (IS) or insulin-providing (IP) has now
shown that IS therapy significantly reduced
the cumulative diabetic peripheral neuropa-
thy in the four-year follow-up period.
Source: Busui RP,
et al
.
Impact of glycaemic control
strategies on the incidence of DPN in the Bypass Angi-
oplasty Revascularisation Investigation 2 Diabetes (BARI
2
D) cohort.
J Aalbers
SYMPOSIUM ON SLEEP DISORDERS
AND DIABETES
Sleep duration and quality and
diabetes risk
Dr E Tasali, Chicago, USA, showed evidence
to suggest that decreased sleep duration or
quality may increase diabetes risk. Habitu-
ally short sleep duration or quality (low
levels of slow-wave sleep) increases sympa-
thetic nervous system activity, which leads
to insulin resistance and, in the long term,
may compromise beta-cell function to
cause type 2 diabetes mellitus.
Sleep apnoea and diabetes risk
Dr N Punjabi, Baltimore, USA, concluded
that, independent of other risk factors,
obstructive sleep apnoea increases the risk
of developing type 2 diabetes mellitus.
Mechanisms of insulin resistance in
sleep apnoea
Dr O’Donnell, Pittsburgh, Pennsylvania,
presented data from animal studies on the
mechanism of insulin resistance in sleep
apnoea. These studies suggest that increased
sympathetic nervous system activity, frag-
mented sleep causing dysregulation of the
hypothalamic–pituitary axis, endothelial dys-
function and alterations in cytokine and adi-
pokine release are all putative mechanisms
for insulin resistance in sleep apnoea.
SYMPOSIUM ON THE EFFECTS OF
BARIATRIC SURGERY ON MATER-
NAL AND OFFSPRING OUTCOMES
Effects of restrictive and mal-
absorptive bariatric surgery on
reproductive-age women: fertility,
metabolic effects and contraception
Dr Melinda Maggard-Gibbons, associate
professor of Surgery at UCLA discussed
the effects of restrictive and malabsorp-
tive bariatric surgery on reproductive-age
women. While the literature suggests that
there is an improvement in fertility post-
bariatric surgery, there are not enough data
to draw a conclusion about the impact of
bariatric surgery on
in-vitro
fertilisation suc-
cess. There is a concern about the absorp-
tion of the oral contraceptive pill in patients
who have undergone bariatric surgery, and
additional barrier methods of contracep-
tion are suggested.
Approach to managing the post-
bariatric patient during pregnancy,
including impact on pre-gestational
and gestational diabetes and
hypertension
Eyal Sheiner, an obstetrician from Israel,
described an approach to managing the
post-bariatric patient during pregnancy.
Pre-pregnancy weight loss and careful
pre-conception screening of patients for
nutritional deficiencies is the ideal. There
were lower rates of hypertensive emergen-
cies, diabetes and gestational diabetes in
