Page 50 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)

192 VOLUME 9 NUMBER 4 • NOVEMBER 2012
REPORT SA JOURNAL OF DIABETES & VASCULAR DISEASE
reduced by almost the same degree.
The conclusion for diabetic patients and
their primary-care team is that it is never
too late to enter an exercise programme.
Most type 2 diabetes patients
experience hypoglycaemia
According to the GAPP2 (Global Attitudes
of Patients and Physicians Survey), 80%
of type 2 diabetes patients experience
hypoglycaemia, with almost 40% experi-
encing an episode in the previous month.1
Nearly half of the patients reported
increased blood glucose monitoring as a
result of their last episode and 10% also
altered their long-acting insulin regime;
16% said they missed an insulin dose and
14% intentionally kept their levels higher
than recommended in order to avoid
hypoglycaemia during the night.
Healthcare professionals said that their
prescribing decisions were influenced by
the risk of hypoglycaemia. This resulted
in 57% of health professionals starting
patients on a lower dose of long-acting
insulin than recommended.
1. Tahrani A, et al. Abstract 222. Presented at the
48th European Association for the Study of
Diabetes (EASD) annual meeting, Berlin, Germany,
1–5 October 2012.
Insulin degludec shows 43% lower
rates of night-time hypoglycaemia
than insulin glargine
New data presented at the EASD show that
patients with type 2 diabetes starting insu-
lin therapy had a 43% lower rate of night-
time hypoglycaemia when using insulin
degludec compared with those using insu-
lin glargine (for insulin degludec 0.27 vs for
insulin glargine 0.46 episodes per patient
per year, p < 0.001), with equivalent
improvements in glucose control. 1
In this two-year (one year initial and one
year extension) phase 3a study, comparing
the efficacy and safety of once-daily insulin
degludec versus once-daily insulin glargine
( both in combination with OADs), the
rates of overall hypoglycaemia were simi-
lar between the two groups (insulin deglu-
dec 1.72 vs insulin glargine 2.05 episodes
per patient per year, p = NS). Furthermore,
while the rates of severe hypoglycaemia
were infrequent, they were significantly
lower with insulin degludec compared with
insulin glargine (insulin degludec 0.01 vs
insulin glargine 0.02 episodes per patient
per year, p = 0.02). This randomised, open-
label, treat-to-target study included 1 030
patients with type 2 diabetes not previously
treated with insulin, of which 659 com-
pleted two years of treatment.1
‘Hypoglycaemia, and particularly night-
time hypoglycaemia, is a major concern for
people living with diabetes and the prin-
cipal limiting factor to effective glucose
control, thereby increasing their risk of
long-term complications’, said Dr Helena
Rodbard, lead author and medical direc-
tor, Endocrine and Metabolic Consultants,
Rockville, Maryland. ‘The reduction in rates
of nocturnal hypoglycaemia with insulin
degludec will hopefully allay some of this
concern and encourage patients and phy-
sicians to aim for more ambitious glucose
targets.’
1. Rodbard HW, et al. Reduced nocturnal hypo-
glycaemia with insulin degludec as compared to
insulin glargine: results of a 2–year randomised
trial in type 2 diabetes. Poster presented at the
EASD 48th annual meeting, October 2012.
Cholesterol target not achieved in
most people with diabetes
More than half of people with diabetes are
not having their cholesterol levels regulated
despite the availability of effective drug
therapy, according to a new UK study. An
analysis of the latest National Audit for Dia-
betes by Diabetes UK shows that although
91.6% of people with diabetes are now
receiving annual checks for the condition,
about 60% of those receiving the checks
are not meeting their annual cholesterol
targets. These results suggest that health-
care professionals are not acting on the
check results.
The cholesterol check is one of the 15
healthcare essentials, based on NICE guide-
lines, which set out a minimum standard
of care that people with diabetes need to
help manage their condition. As with all
15 healthcare essentials, taking a measure-
ment marks only the first step in appropri-
ate management.
Target cholesterol level should be
achieved. Making improvements should
be straightforward with effective statin
therapy.
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