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The American Diabetes Association’s (ADA) 2017 Standards of Care1 were published in Diabetes Care on 15 December 2016. Notable changes in the new guidelines include the recommendation of sodium-glucose cotransporter 2 (SGLT-2) inhibitor empagliflozin and glucagon-like peptide 1 (GLP-1) agonist liraglutide for type 2 diabetes (T2D) patients at high risk for cardiovascular morbidity and mortality. Data from the Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) trial2 and the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial3 are now included in the section on cardiovascular disease and risk management. In addition, fixed-ratio combinations of a basal insulin and a GLP-1 agonist are included in the algorithm for combination therapy, just weeks after the first of these products, Novo Nordisk’s (Copenhagen, Denmark) Xultophy (insulin degludec/liraglutide) and Sanofi’s (Paris, France) Soliqua (insulin glargine/lixisenatide), were approved by the US Food and Drug Administration (FDA) for prescription in the US. Based on recommendations from the International Hypoglycemia Study Group,4 the ADA’s 2017 Standards of Care features a new classification for hypoglycemia: clinically significant hypoglycemia is now defined at blood glucose levels <54 mg/dL, whereas blood glucose levels <70 mg/dL should be used as an “alert value” to help individuals avoid more severe hypoglycemia. The ADA’s new guidelines also include a greater emphasis on cost of diabetes drugs, T2D prevention (with a push for more frequent prediabetes screenings), and psychosocial support in diabetes care, especially for adolescents and pediatric patients. The 14th Annual World Congress on Insulin Resistance, Diabetes, and Cardiovascular Disease took place in Los Angeles (CA, USA) from 1 to 3 December 2016, drawing almost 500 attendees. A presentation on the promise of fibroblast growth factor (FGF)-1 in reversing insulin resistance discussed how FGF-1 administration to genetically obese mice can normalize blood glucose levels, improve insulin sensitivity, and lower liver fat levels through action at the adipocyte FGF-1 receptor. Although FGF-1 has a short half-life when administered systematically, studies of optimized FGF-1 analogs have demonstrated the possibility of longer-term glucose-lowering effects. These analogs offer the added benefit of no thiazolidinedione (TZD)-like side effects, and could present a management of T2D. This meeting featured a discussion of the TZD class of agents as well, and a presentation of major findings from the Insulin Resistance Intervention after Stroke (IRIS) trial.5 Treatment with the insulin-sensitizing TZD pioglitazone over the course of 5 years reduced the relative risk of stroke and myocardial infarction by 24% (P = 0.007), reduced the incidence of new-onset diabetes by 52% (P < 0.001), and reduced the relative risk of acute coronary syndrome by 25% compared with placebo. All participants in the IRIS trial were patients with a recent history of stroke or transient ischemic attack who were found to have insulin resistance, but who did not have diabetes (n = 3876). Thiazolidinediones have been associated with undesirable side effects, namely weight gain and edema, although this side effect profile is thought to be more benign with lower doses.
Marathe et al. (Tue,) studied this question.