VOLUME 8 NUMBER 3 • SEPTEMBER 2011
129
SA JOURNAL OF DIABETES & VASCULAR DISEASE
ADA WATCH
and utilisation was reduced in these cells.
The effect on the adipocyte was less evi-
dent.
Source: Abstract 2552 – poster. Mazibuko SE, Muller
CJF, Pheiffer C, Opoku A, Louw J. The
in vitro
effects
of saturated and unsaturated fatty acids on insulin
stimulated glucose metabolism of myocytes and
adipocytes.
PATHOPHYSIOLOGY OF TYPE 1
DIABETES
Glycaemic control and incidence
of heart failure in young type 1
diabetes patients
In patients with poor glucose control (HbA
1c
≥ 10.5%), the risk of heart failure was four
times higher than in patients with very good
control (HbA
1c
<
6.5%). Risk of heart failure
increased with age and duration of diabe-
tes, and each 1% increase in HbA
1c
level
resulted in a 30% higher risk of heart fail-
ure during follow up. This data comes from
a Swedish registry of more than 20 000
patients with a mean age of 38.6 years.
In the follow-up period of nine years, 3%
of patients were admitted to hospital with
a primary or secondary diagnosis of heart
failure. This is the first cohort-based study
determining the incidence of heart failure
in type 1 diabetes patients only, although
the UKPDS indicated a similar rate of heart
failure (3%) in type 2 diabetes patients over
10 years.
In comparison with Swedish figures for
heart failure rates in male non-diabetics, the
presence of poorly controlled type 1 diabe-
tes leads to a similar event rate 20 years ear-
lier (41–45 years) than in their non-diabetic
counterparts. Patients 55 to 64 years of age
have an event rate of 2.1 per 1 000 person-
years.
Source:
Lancet
/ADA Symposium and Lind M,
et al
.
Glycaemic control and incidence of heart failure in 20
985 patients with type 1 diabetes: an observational
study. Publish online. June 25 2011. DOI:10.1016/50140-
6736(11)60471-6.
PHARMACOLOGICAL TREATMENT
OF DIABETES
New ultra long-acting insulin:
insulin degludec matches insulin
glargine in both type 1 and type
2 diabetes patients, with less
hypoglycaemia
1
A new insulin formulation, insulin deglu-
dec, under development by Novo Nordisk,
lowers glucose levels with significantly less
hypoglycaemia than insulin glargine. This
study was a two-phase, 52-week clinical trial
conducted first in type 1 diabetes patients,
and second, in type 2 diabetes subjects.
The studies were designed as treat-to-
target studies, i.e. aiming to reach similar
glycaemic targets with both insulin formats.
Similar reductions in HbA
1c
levels were
achieved with both insulins; 0.4% reduc-
tion in HbA
1c
in type 1 diabetes patients and
1.2% in type 2 diabetes subjects.
In type 2 diabetes patients, there were
significantly fewer hypoglycaemic events
with insulin degludec compared to those
given insulin glargine (11.1 vs 13.6 episodes/
patient year;
p
= 0.0359). Importantly, rates
of nocturnal hypoglycaemia were much
lower with insulin degludec compared to
insulin glargine in both type 1 and 2 diabe-
tes patients.
A separate study presented in the late-
breaking session
2
showed the flexibility of
usage of insulin degludec, which can be
given at different times from day to day in
patients with type 2 diabetes. Even when
given at 40-hour intervals, overall glycae-
mic control was not affected nor did risk of
hypoglycaemia increase.
In this study of insulin degludec usage,
the insulin was given once daily at greater-
than-daily intervals by alternating morning
and evening injections from day to day.
Reductions in HbA
1c
levels with this usage
strategy were similar to those with insulin
glargine.
Sources: 1. Garber A. Insulin degludec improves
long-term glycaemic control with less nocturnal
hypoglycaemia compared with insulin glargine: 1-year
results from randomised basal-bolus trial in patients
with type 2 diabetes. NN 1250-3582. Heller S. Insulin
degludec improves long-term glycaemic control
with less nocturnal hypoglycaemia compared with
insulin glargine: 1-year results from randomised basal-
bolus trial in patients with type 1 diabetes. NN 1250-
3583.
2. Meneghini L. Flexible once daily dosing of insulin
degludec does not compromise glycaemic control or
safety compared to insulin glargine given once daily at
the same time each day in people with type 2 diabetes.
NN 1250-3668.
Insulin addition to GLP-1 receptor
agonist (GLP-1RA) therapy in type 2
diabetes
There are very few data available on insu-
lin therapy added to the therapy of patients
with type 2 diabetes who are on GLP-1
receptor agonists and metformin; although
there is a significant body of evidence
related to the value of GLP-1RAs added to
insulin therapy in this condition.
This study evaluated the efficacy and
safety of liraglutide 1.8 mg added to met-
formin, followed by insulin detemir titrated
from 10 mg/kg for those whose HbA
1c
level
was still above 7%. After 12 weeks of treat-
ment with liraglutide plus metformin, 61%
of patients reached the target HbA
1c
level
of less than 7%, and lost 4.4 kg of body
weight.
Continuing for a further 26 weeks,
patients who received insulin detemir low-
ered their HbA
1c
levels by a further 0.5%.
Those who remained on only liraglutide
and metformin achieved stable HbA
1c
levels
without further increase in this period of
time.
The addition of insulin increased the
percentage of patients achieving an HbA
1c
level of less than 7%, from 17 to 43%;
more than doubling those who reached
targeted glucose control. Of interest to
clinicians is that patients maintained their
weight loss despite the addition of insulin
detemir.
Source: Abstract No 0276 – oral presentation. Rosen-
stock J, de Vreis JH, Seufert J,
et al
. Pharmacological
treatment of diabetes. A new type 2 diabetes treatment
paradigm: Sequential addition of liraglutide to met-
formin and then insulin detemir.
Metformin still at core of first-line
treatment for type 2 diabetes in
focus on older patients
Sulfonylurea (SU) therapies have been asso-
ciated with the potential for increased risk
of cardiovascular disease (CVD), but remain
a commonly used antihyperglycaemic med-
ication, particularly in the elderly.
This retrospective cohort study examined
the potential association between initial
monotherapy with SU or metformin (MET)
and subsequent CVD in older patients with
T2DM. A cohort of patients who were ≥
65 years old with T2DM, and had received
their first prescription of SU or MET mon-
otherapy between 2003 and 2007 and
remained on it for at least 90 days, were
selected from the electronic medical record
database.
Patients also had to have had no anti-
hyperglycaemic treatment and CVD events
[ischaemic heart disease (IHD), myocar-
dial infarction, stroke, transient ischae-
mic attack and peripheral arterial disease]
within the prior year (baseline) and also
have had at least two years of follow up
after the first treatment.
