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VOLUME 8 NUMBER 3 • SEPTEMBER 2011
ADA WATCH
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Logistic regression evaluated the likeli-
hood of having a CVD event. Cox regres-
sion estimated time to first CVD event.
Differences in baseline characteristics
(demographics, clinical and laboratory
measures, and co-morbidities) were con-
trolled for using propensity score matching
(PSM).
Overall, 8 502 patients were included,
with 4 251 per group. Mean age was 75
years and 49% were males. While control-
ling for differences in baseline characteris-
tics using PSM, patients who initiated with
SU had a significantly higher (p < 0.001)
incidence of CVD events (12.4%) compared
to those initiated with MET after two years
of follow up.
The difference was mainly driven by the
increased incidence of IHD with SU (7.2%)
compared to MET (5.5%) (p = 0.002). The
likelihood of having a CVD event was higher
in patients initiated with SU than with MET
(95% CI = 1.08–1.41; p = 0.002). SU use
was also associated with shorter time to
first CVD event compared to MET (95% CI
= 1.03–1.28; p = 0.004)
Source: Abstract 0038 – oral presentation. Fu AZ, Qiu
Y, Davies MJ, Engel SS. Risk of cardiovascular disease
associated with sulfonylurea or metformin use in older
patients with type 2 diabetes.
Once-weekly exenatide shows
continued benefits at 18 months in
Duration-3 study
Type 2 diabetes patients treated with once-
weekly exenatide continued to experience
improved glycaemic control, sustained
weight loss and fewer hypoglycaemic
events than patients treated with glargine.
This benefit was seen when exenatide or
glargine was added to metformin mono-
therapy treatment or to therapy with met-
formin and suphonylurea.
Importantly, discontinuations did not
differ between patients receiving exenatide
or glargine, although diarrhoea, nausea
and vomiting, and injection site nodules
occurred more frequently with exenatide
treatment.
In this period, to maintain HbA
1c
levels below 7%, insulin glargine dosage
increased from 31.1 (SE 1.4) IU at 26 weeks
to 34.8 IU at 84 weeks. Between-therapy
benefit of 4.5- to 5-kg weight loss was
seen with exenatide compared to glargine.
Overall incidence of minor hypogly-
caemic events was significantly less in the
exenatide group compared to glargine,
regardless of whether the patient was on
monotherapy with metformin or metformin
plus sulphonylurea therapy.
Source: Abstract 0277 – oral presentation. Diamant M,
Van Gaal L, Stranks S, Guerci B, Macconell L, Trautmann
M. Duration-3: Efficacy of exenatide once weekly (EOW)
and insulin glargine QD (IG) after 84 weeks in patients
with type 2 diabetes (T2D).
Insulin glargine less effective in
women?
A pooled evaluation of nine clinical trials
assessed the impact of gender on HbA
1c
levels, insulin dose and incidence of hypogly-
caemia in type 2 diabetes patients treated
with insulin glargine compared to other
oral-therapy antidiabetic agents and other
insulins (NPH, Premix, Lispro) and diet.
While insulin glargine produced greater
mean HbA
1c
reductions at week 24 versus
competitors, women had smaller reduc-
tions in HbA
1c
levels and were less likely to
reach glycaemic goals despite higher insulin
doses and greater frequency of hypoglycae-
mic events.
Source: Abstract 2264 – publish only. McGill JB, Vlajnic
A, Knutsen PG, Recklein C, Rimler MS, Fisher SJ. Effect
of gender outcomes in patients with T2D treated with
insulin glargine vs competitors.
Early intensive dietary intervention
improves glycaemic control in type
2 diabetes
Early intensive dietary intervention with a
dietary consultation and follow up every six
months improves glycaemic control, while
the addition of promotion of physical activ-
ity did not achieve any further benefit.
The Early Activity in Diabetes (Early ACTD)
trial set out to investigate whether increased
physical activity would have effects on gly-
caemia over and above the dietary interven-
tion. The study included some 600 patients,
and a control group receiving usual care
consisted of 100 patients.
Over the 12-month period, glycaemic
control worsened in the standard-care
group, while HbA
1c
levels improved in the
diet group and the diet-plus-activity group.
There was less use of antidiabetic drugs and
an improvement in body weight and insulin
resistance in the intervention groups. Blood
pressure was similar across all three groups.
Source: Andrew RC,
et al
.
Lancet
symposium and ADA
and published in the
Lancet
, online – DOI:10.1016/
S0140-6736(11) 60442-X.
Look Ahead Lifestyle trial: four-year
data
Look Ahead, a 13-year trial in the USA of
overweight and obese patients with type 2
diabetes, has shown at year four that the
intensive lifestyle-intervention group was
not able to sustain the benefits achieved at
the end of the first year.
However, there was some good news in
the severely obese group who initially lost
9% of their body weight, but were able at
year four to still show a 5% weight loss.
This weight gain was similar to that seen in
the less obese patients.
This trial has enrolled 5 000 patients
and is funded by the National Institute of
Health. Eight-year data is currently being
collected. Severely obese patients are nor-
mally excluded from type 2 diabetes trials,
so these data are important and offer a
useful alternative to bariatric surgery.
Importantly, the trial showed a 10% or
greater weight loss at four years, and nearly
50% of those who lost 10% at year one
sustained this weight loss to the end of year
four. A significant number of patients (11%)
also achieved complete reversal of their dia-
betes and were able to stop taking medica-
tion at year four (8%). This compares to only
3% in the standard-intervention group.
Source: Look Ahead Symposium. ADA 2011.
Brief highlights from the oral poster
sessions
M• ajor depression independently pre-
dicted increased mortality from mac-
rovascular events in the ACCORD trial
[Abstract 0048-OR].
HbA •
1c
level misclassifies patients in
a Veterans Administration study of
mainly black (male) patients [Abstract
0042-OR].
Resting energy expenditure is sup-
•
pressed equally by large weight loss
compared to bariatric surgery [Abstract
0055-OR].
Diet soft drinks are not free of conse-
•
quences and frequent use of these
drinks is associated with increased
weight circumference and visceral obes-
ity [Abstract 0062-OR].
Basal insulin treatment immediately
•
following renal transplantation effec-
tively prevents new-onset diabetes
by providing beta-cell rest [Abstract
0072-OR].
Elevated uric acid level may still be
•
shown to be an important therapeutic
